Karen L. et al v. Health Net, PHS, et al.

Second Circuit Court of Appeals

___ F.2d ___, 2003 U.S. App. LEXIS 21963 (2nd Cir. 2003)

October 24, 2003


The Second Circuit Court of Appeals affirmed a lower court’s denial of plaintiffs’ request for a preliminary injunction on behalf of all Health Net Medicaid recipients seeking to challenge the Medicaid Managed Care Organization’s (“MCO”) pre-authorization prescription plan as part of a “reclassification” program. In Karen L. v. Health Net, et al, the circuit court found that the district court had not abused its discretion because its decision had not rested on an error of law or a clearly erroneous factual finding. The district court’s rationale — namely that there was no evidence to show that any Medicaid recipient was threatened by denying Medicaid recipients non-formulary medications — met the legal standard because the MCO had send the recipients, as well as their physicians and pharmacists, a notice indicating the change and encouraging patients and physicians to notify Health Net if the drug was medically necessary. The brief decision may be accessed on the Second Circuit Court of Appeal’s web site by going tohttp://www.ca2.uscourts.gov/.

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