State & Sch. Emps.' Life & Health Plan v. KCC, Inc.

• Decision Date: 07 March 2013
• Docket Number: No. 2011–CA–01716–SCT.,2011–CA–01716–SCT.
• Citation: 108 So.3d 932
• Parties: MISSISSIPPI STATE AND SCHOOL EMPLOYEES' LIFE AND HEALTH PLAN and Catalyst RX d/b/a Catalyst RX, Inc. v. KCC, INC., an Alabama Corporation d/b/a Vital Care of Meridian.
• Court: Mississippi Supreme Court

108 So.3d 932

MISSISSIPPI STATE AND SCHOOL EMPLOYEES' LIFE AND HEALTH PLAN and Catalyst RX d/b/a Catalyst RX, Inc.

v.KCC, INC., an Alabama Corporation d/b/a Vital Care of Meridian.

No. 2011–CA–01716–SCT.

Supreme Court of Mississippi.

March 7, 2013.

Wilson D. Minor, Alan M. Purdie, Grenada, William A. Davis, attorneys for appellants.

Richard N. Kessler, Ned Milenkovich, Peter T. Berk, George H. Ritter, Jackson, attorneys for appellee.

Before DICKINSON, P.J., CHANDLER and KING, JJ.

CHANDLER, Justice, for the Court:

¶ 1. Mississippi Code Section 83–9–6(3) provides that “[a] health insurance plan, policy, employee benefit plan or health maintenance organization” may not prohibit a participant from selecting a pharmacy that has agreed to meet the terms, requirements, and reimbursement set forth by the insurer, or deny such a pharmacy the right to participate as a contract provider under the policy or plan. Miss.Code Ann. § 83–9–6(3) (Rev.2011). KCC, Inc., d/b/a Vital Care of Meridian (“Vital Care”) filed a complaint against the Mississippi State and School Employees' Life and Health Plan (“the Plan”) and the Plan's pharmacy benefits manager, Catalyst Rx (“Catalyst”), alleging that the Plan and Catalyst had violated Section 83–9–6 by designating Walgreens Pharmacy as the sole provider of specialty pharmacy services. Later, Vital Care moved for partial summary judgment on the question of whether Section 83–9–6 applied to the Plan. The Chancery Court of the First Judicial District of Hinds County granted Vital Care's motion for partial summary judgment, and the Plan and Catalyst have appealed.

¶ 2. This Court finds that Section 83–9–6 applies to the Plan because it applies to “all health benefit plans providing pharmaceutical services benefits, including prescription drugs, to any resident of Mississippi” and is not ambiguous. Miss.Code Ann. § 83–9–6(1). Therefore, we affirm the grant of partial summary judgment in favor of Vital Care.

FACTS

¶ 3. Vital Care filed its complaint on April 30, 2010. Vital Care alleged that, since 1997, it has provided specialty pharmacy services to residents of Mississippi. Specialty pharmacy services involve dispensing and monitoring use of specialty drugs used for complex medical conditions, such as cancer, multiple sclerosis, and HIV/AIDS.¹ Vital Care's specialty pharmacy services include expertise in complex medical conditions, dispensing complex medications in specialized containers at the appropriate temperature, tailored patient counseling, medication compliance programs, and medical office support. Vital Care alleged that, since 2006, it has participated as an approved provider of specialty pharmacy services under the Plan, and that it has agreed and will continue to agree to provide specialty pharmacy services that meet the Plan's terms and requirements and the Plan's terms of reimbursement.

¶ 4. Vital Care alleged that, before October 2009, the Plan and Catalyst decided to close the Plan's specialty pharmacy network effective January 1, 2010, at which time Walgreens Specialty Pharmacy would become the sole approved provider of specialty pharmacy services under the Plan. This decision was made and implemented by the State and School Employees' Health Insurance Management Board, which administers the Plan. Miss.Code Ann. § 25–15–303(3) (Supp.2012). Vital Care alleged that the Plan and Catalyst took this action after Catalyst received an eight-million dollar payment from Walgreens “in conjunction with forming an entity related to specialty pharmacy services and extending contracts with Walgreens for mail order and specialty pharmacy services.” Vital Care alleged that the Plan and Catalyst's actions violated Section 83–9–6, because Vital Care continues to meet or exceed all requirements for participation in the Plan and has agreed to the terms of reimbursement. Vital Care alleged that closure of the Plan's specialty pharmacy network will cause it to lose a significant number of customers.

¶ 5. Vital Care requested injunctive relief pursuant to Section 83–9–6(6), which provides that “[a] violation of this section creates a civil cause of action for injunctive relief in favor of any person or pharmacy aggrieved by the violation.” Miss.Code Ann. 83–9–6(6) (Rev.2011). Vital Care requested preliminary or permanent injunctive relief to enjoin the Plan and Catalyst from excluding Vital Care from the Plan's specialty pharmacy network, and from informing Plan beneficiaries that Vital Care is not an approved provider of specialty pharmacy services. Vital Care also requested a declaratory judgment that the Plan's decision to close the specialty pharmacy network and select an exclusive provider for specialty pharmacy services violates Section 83–9–6.

¶ 6. After the Plan and Catalyst answered the complaint, Vital Care moved for partial summary judgment limited to the question of whether Section 83–9–6 applies to the Plan. The Plan and Catalyst filed responses, and Vital Care filed a reply to each response. A hearing occurred on October 18, 2010. The chancellor found that no genuine issue of material fact existed and that Section 83–9–6 applies to the Plan. Finding that there was no just reason for delay, the chancellor entered a final judgment under Mississippi Rule of Civil Procedure 54(b), and granted the parties' joint request for a stay pending appeal. The Plan and Catalyst have appealed.

STANDARD OF REVIEW

¶ 7. Summary judgment is appropriate “if the pleadings, depositions, answers to interrogatories, and admissions, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law.” M.R.C.P. 56(c). This Court affords de novo review to the grant or denial of summary judgment. Miss. Dep't of Env. Quality v. Pac. Chlorine, Inc., 100 So.3d 432, 439 (Miss.2012).

LAW AND ANALYSIS

A. Whether Section 83–9–6 Applies to the Plan

¶ 8. The narrow question before the Court is whether Section 83–9–6 applies to the Plan.²Section 83–9–6, enacted in 1994, is known as an “Any Willing Provider” statute. Miss. Laws, 1994, Ch. 475 § 1. Section 83–9–6(1) provides:

83–9–6. Pharmaceutical services and prescription drug benefits

(1) This section shall apply to all health benefit plans providing pharmaceutical services benefits, including prescription drugs, to any resident of Mississippi. This section shall also apply to insurance companies and health maintenance organizations that provide or administer coverages and benefits for prescription drugs. This section shall not apply to any entity that has its own facility, employs or contracts with physicians, pharmacists, nurses and other health care personnel, and that dispenses prescription drugs from its own pharmacy to its employees and dependents enrolled in its health benefit plan; but this section shall apply to an entity otherwise excluded that contracts with an outside pharmacy or group of pharmacies to provide prescription drugs and services.

Miss.Code Ann. § 83–9–6(1) (Rev.2011) (emphasis added). Subsection (2)(c) states that “ ‘Health benefit plan’ means any entityor program that provides reimbursement for pharmaceutical services.” Subsection (3) states, in part:

(3) A health insurance plan, policy, employee benefit plan or health maintenance organization may not:

(a) Prohibit or limit any person who is a participant or beneficiary of the policy or plan from selecting a pharmacy or pharmacist of his choice who has agreed to participate in the plan according to the terms offered by the insurer;

(b) Deny a pharmacy or pharmacist the right to participate as a contract provider under the policy or plan if the pharmacy or pharmacist agrees to provide pharmacy services, including but not limited to prescription drugs, that meet the terms and requirements set forth by the insurer under the policy or plan and agrees to the terms of reimbursement set forth by the insurer;....

Miss.Code Ann. § 83–9–3(3). Subsections (6)-(9) provide:

(6) A violation of this section creates a civil cause of action for injunctive relief in favor of any person or pharmacy aggrieved by the violation.

(7) The Commissioner of Insurance shall not approve any health benefit plan providing pharmaceutical services which does not conform to this section.

(8) Any provision in a health benefit plan which is executed, delivered or renewed, or otherwise contracted for in this state that is contrary to this section shall, to the extent of the conflict, be void.

(9) It is a violation of this section for any insurer or any person to provide any health benefit plan providing for pharmaceutical services to residents of this state that does not conform to this section.

Miss.Code Ann. § 83–9–6(6)–(9).

¶ 9. The Plan does not dispute that it is a “health benefit plan” as defined in Section 83–9–6(2)(c), or that Section 83–9–6(1) applies to “all health benefit plans.” The Plan contends that, because other statutes conflict with Section 83–9–6, there is ambiguity as to whether Section 83–9–6 applies to the Plan. The Plan argues that, due to this ambiguity, this Court must engage in statutory construction and reach the conclusion that the Legislature did not intend for Section 83–9–6 to apply to the Plan. Vital Care argues that Section 83–9–6 is not ambiguous, because the word “all” plainly encompasses all health benefit plans, including the Plan.

¶ 10. “When the language used by the legislature is plain and unambiguous ... and where the statute conveys a clear and definite meaning ... the Court will have no occasion to resort to the rules of statutory interpretation.” Miss. Ethics Comm'n v. Grisham, 957 So.2d 997, 1001 (Miss.2007) (quoting Marx v. Broom, 632 So.2d 1315, 1318 (Miss.1994)). “Courts have a duty to give statutes a practical application consistent with their wording, unless such application is inconsistent with the obvious intent of the legislature.” Grisham, 957 So.2d at 1001 (quot...