B.R. v. District of Columbia is a class action lawsuit brought in 2010 by TPM and the National Health Law Program (NHeLP) challenging the District of Columbia’s failure to provide individualized written notice to persons whose prescriptions are denied Medicaid payment at the point-of-sale. Plaintiffs contend that this violates their right to due process guaranteed by the Fifth Amendment to the Constitution.

The putative class currently consists of:

All persons who have applied for, received, or are receiving DC Medicaid that present a prescription to a participating pharmacy for a covered medication, and who do not, or will not, receive timely, adequate individualized written notice when the prescription is denied or is not filled as written.

Current Status

This case is again before Judge Richard J. Leon of the District of Columbia District Court, following Plaintiffs’ appeal that was decided in 2023.  However, on May 2, 2024, Judge Leon stayed all proceedings in the case until he decides whether allow Plaintiffs to amend their Complaint to substitute new named Plaintiffs.  In the order staying the case, Judge Leon informed Plaintiffs that “any prejudice to the plaintiffs [caused by staying their case] will be minimal, given that the stay is expected to be brief while the Court assesses the pending motions.”

On March 10, 2023, the United States Court of Appeals for the District of Columbia reversed for the third time the dismissal of this case by the District Court finding that the District of Columbia had not met its heavy burden to show that the case was moot.  

The District of Columbia had argued that case was moot based on its issuance of a transmittal memorandum in January 2020 asking pharmacies to give notice to Medicaid beneficiaries when Medicaid denies prescription coverage.  In response, Plaintiffs conducted a survey of 16 pharmacies in all eight wards of the District and found that 13 of the 16 pharmacies were not issuing individualized written notice to people when their Medicaid prescriptions were denied coverage.

The Court of Appeals found that the case is not moot and specifically instructed Judge Leon to “proceed expeditiously” and “allow plaintiffs to make their case.”  That decision, along with various other filings and orders related to this case, are located to the left.  

If you have any questions about the case or are a District of Columbia Medicaid recipient who has had problems obtaining Medicaid coverage for your prescribed medications at the pharmacy, please contact Michael Huang at 202-204-8479 or mhuang@tpmlaw.com.

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