735 F.2d 1502 | D.C. Cir. | 1984
Opinion for the Court filed by Circuit Judge WILKEY.
This case arises from a challenge by appellee Pfizer Inc. to the application of a regulation by the Department of Health and Human Services to a patented drug. The regulation establishes procedures whereby a maximum allowable cost (“MAC”) may be set for a prescription drug for the purposes of limiting payment or reimbursement from federal funds under the Medicare and Medicaid programs. Pfizer contends that the regulation does not apply to patented drugs. The district court granted summary judgment for Pfizer and enjoined appellant Margaret M. Heckler, Secretary of Health and Human Services, from imposing a maximum allowable cost on government purchases and reimbursement- for the patented drug Doxepin Hydrochloride pursuant to the regulation.
I.The Regulatory Scheme
The Medicare and Medicaid statutes require -that the federal government pay providers of medical services the reasonable cost of those services, excluding any part of the incurred cost which is unnecessary to the efficient delivery of health care services. In addition, payments made under federal grants to the states for medical assistance programs must be consistent with efficiency, economy, and quality of care.
In 1975 the Secretary of the Department of Health, Education and Welfare
The procedures in the MAC regulation for establishing a MAC limit for a particular drug begin with the identification of a drug as a candidate for the MAC program. The MAC regulation establishes the Pharmaceutical Reimbursement Board (“the Board”) comprised of six employees of the Department, which identifies the specific drugs for which a MAC limit may be set. The regulation controls which types of drugs may be identified by the Board for MAC limits. It provides: “The Board shall identify those multiple source drugs for which significant amounts of Federal funds are or may be expended ... and for which there are or may be significantly different prices.”
The MAC regulation requires the Board to notify the Food and Drug Administration (“the FDA”) of each drug identified for a MAC limit. The purpose of the Board’s notification is to obtain the FDA’s judgment about the bioequivalency of the multiple source drug as well as its advice on other considerations relevant to the marketability of the drug. If the FDA does not advise delaying the establishment of a MAC, the Board proceeds to establish a proposed maximum allowable cost for the particular drug that has been identified.
The MAC regulation provides that price competition in the market shall be the basis upon which the MAC limit is set. The regulation states, “[T]he Board shall make an initial determination of the lowest unit price at which the drug is widely and consistently available from any formulator or labeler.”
II.The Doxepin HCl Proceedings
The Pharmaceutical Reimbursement Board identified Doxepin HCl (“Doxepin”) —an antidepressant drug — as a MAC candidate in 1977. Doxepin is marketed by two different suppliers in the United States: appellee Pfizer Inc., and Pennwalt Corporation, which is not a party in this litigation. Pfizer obtained a patent on Doxepin in 1969 and markets the drug under the trademark name “Sinequan.” Pennwalt Corporation markets the drug
The Board determined that the lowest unit price at which Doxepin was widely and consistently available corresponded to the prices charged by the licensee, Pennwalt Corporation, as opposed to the patent holder, Pfizer, for specified capsule dosages of Doxepin. The Board published a notice in the Federal Register proposing MAC limits that were based on Pennwalt’s lower prices for Doxepin capsules of 10, 25 and 50 milligrams.
After the public hearing, the Board published slightly modified, final MAC limits for 10, 25 and 50 milligram capsules of Doxepin in December 1978.
The MAC regulations provide that the Board is to identify those multiple-source drugs for which significant amounts of Federal funds are expended and for which there are significant different prices. The Board is then to determine the lowest unit price at which the drug is widely and consistently available. The MAC regulations make no mention of patents. The Board, of course, could not MAC a patented drug where the patent-holder had retained his legally protected monopoly and distributes only one form of the drug. In such a case, the drug product would not be a “multiple-source drug.” Where, however, a patentholder has licensed another, and the licensee is producing and distributing the drug, the drug becomes “multiple-source” and thus becomes a candidate for MAC limits. In this instance, Pfizer has licensed Pennwalt, and it is the Pennwalt product upon which the MAC price is based.15
Subsequently the Board also set a final MAC limit for 100 mg. dosage capsules of Doxepin in 1979.
These two MAC determinations were the subject of complaints filed by Pfizer in the District Court for the District of Columbia.
On 29 June 1983 the district court granted Pfizer’s motion for summary judgment on the ground that the Board was precluded from establishing a MAC for Doxepin because the drug is subject to a patent. Because it granted judgment for Pfizer on
III. Interpreting the MAC Regulation
It is axiomatic that an administrative agency is bound by its own regulations.
A. The Plain Meaning of the MAC Regulation
Our construction of the MAC regulation must begin with the words in the regulation and their plain meaning. On its face, the MAC regulation permits a MAC to be established for any “multiple source” drug, provided only that the drug is one for which significant amounts of federal funds are expended and which is available at significantly different prices.
B. The Purpose of the MAC Regulation
This construction of the MAC regulation based on its plain language is consistent with the avowed purpose of the MAC program. The objective of the MAC regulation is to permit the government to act as a prudent customer in expending federal funds for prescription drugs when there is price competition in the market for a particular drug. This underlying purpose of the MAC regulation does not support the exclusion of multiple source patented drugs from the MAC program.
The express purpose of the MAC program and the Department interpretation of the regulation were reiterated in the Notice of Final Rule Making for the MAC regulation. In published responses to comments submitted on- the proposed MAC regulation, the Department stated:
[A] number of drug containing the same active ingredients in the same dosage forms and strengths are available from different formulators and labelers at significantly different prices. In light of this fact and in the interest of the efficient administration of the duties with which the Secretary is charged, consistent with quality care, the MAC regulation is issued to take advantage of these varying multiple-source drug prices.27
In accordance with this purpose of allowing the government to take advantage of price competition in the market, the extensive published preamble to the final MAC regulation emphasized the distinction between drugs available from a single source, for which there would be no price competition, and those available from two or more sources at different prices. This distinction in the MAC regulation is intended to isolate factors which indicate the presence of price competition in the market for a particular drug. The preamble in the Notice of Final Rule Making does not mention patented drugs, because the status of a drug as patented or not is irrelevant to the effectuation of the MAC regulation’s purpose of enabling the government to take advantage of price competition. The crucial distinction is whether a product is a single source or a multiple source drug.
Thus the MAC scheme as construed by its plain language and express purpose is simple. When a drug is available only from a single source, whether or not the drug is patented, reimbursement from public funds is limited to the lower o'f: (1) the acquisition cost plus a reasonable dispensing fee; and (2) the provider’s usual charge to the public for the drug. When, however a drug is available from two or more sources, it may be a candidate for MAC limits regardless of its patented status, provided only that significant federal funds are expended for the drug and that it is available at significantly different prices.
While the Secretary might (with sufficient evidentiary support) have chosen to make an exception for patented drugs, such an exception is certainly not mandated by the purpose of the MAC program. Indeed, such an exception, while arguably serving other desirable ends, would affirmatively frustrate that purpose with regard
C. The Inflation Impact Statement
Despite the MAC regulation’s clear language and'its express purpose, Pfizer contends that the Inflation Impact Statement issued when the final MAC regulation was published exempts patented drugs from the MAC regulation. Pfizer relies on several references to patented drugs in the Statement, which Pfizer contends limit the scope of the MAC regulation to nonpatented multiple source drugs. Pfizer claims that the Statement is a contemporaneous interpretation of the regulation by the agency charged with its enforcement and that, therefore, the Statement’s interpretation is entitled to substantial deference by this court on review.
The Inflation Impact Statement comprises the results of a study conducted by the Department on the costs and savings expected to flow from the MAC program. While the Statement is mentioned in the published preamble to the final MAC regulation,
As a threshold matter, we decline to give the Statement controlling weight in interpreting the MAC regulation because the language of the regulation itself is clear and unambiguous. Under settled principles of statutory and rule construction, a court may defer to administrative interpretations of a statute or regulation only when the plain meaning of the rule itself is doubtful or ambiguous. The Supreme Court held in Udall v. Tallman that a court should be guided by an administrative construction of a regulation only “if the meaning of the words used is in doubt."
In the instant ease, the operative parts of the MAC regulation are clear and unambiguous. MAC limits may be established for any multiple source drug for which federal funds are significantly expended and which is available at significantly different prices. Multiple source drugs are defined as those drugs that are available from two or more sources. There simply is no doubt or ambiguity in the operative definitions in the regulation as to whether multiple source drugs that are patented may be candidates for the MAC program. Language in the Inflation Impact Statement cannot control the plain meaning of the MAC regulation.
Under these standards of construction, the Inflation Impact Statement merits little deference on the issue now before the court. The Statement is not the product of adjudication nor is it rulemaking by the Department. The Statement was not formally published either as a response to comments submitted about the proposed MAC regulation or as a preamble to the final regulation. More importantly, the Statement does not purport to be a formal, reasoned interpretation of the scope of the MAC regulation. The inflation impact study was apparently conducted, at least in part, pursuant to an Executive Order which required the Department to evaluate the inflationary impact of proposed rules and regulations.
Furthermore, such an interpretation of the MAC regulation by the Statement would not merit deference due to its inconsistency with other, published statements of the Department. Skidmore v. Swift counsels against deference to an agency’s interpretation by a reviewing court if that interpretation is not consistent with other pronouncements of the agency. In the instant case, the Department on several occasions has clearly indicated that the MAC regulation applies to all multiple source drugs. For example, the Notice of Proposed Rule Making published together with the proposed MAC regulation in 1974 clearly and unequivocally stated that the proposed MAC regulation would apply to “all multiple-source drugs”.
More fatal to Pfizer’s claim, however, even than the fact that the Statement warrants little or no deference by this court in construing the clear mandate of the MAC regulation, is the fact that the Statement does not interpret the MAC regulation to exclude patented drugs. Thus even if this court were required to give weight to language in the Inflation Impact Statement, the Statement does not posit an exemption from the regulation for multiple source drugs which are patented.
The decision to engage in research activities rests on the anticipated costs and benefits. The proposed regulations do not affect the cost of research and development. Since the patent system affords protection from competition to the originator of a new drug for 17 years from the date of the patent, the MAC program would not affect the price or sales of any patented product during this period. Only when patent protection ends will the product be subject to a MAC limit. While the profitability of the product may decline somewhat as a result of the application of the MAC regulations this occurs so far in the future (when viewed from the point at which the research decision is made) that the benefits from research are not significantly affected.36
Elsewhere the Statement discusses patented drugs in the context of projected savings from the establishment of MAC limits: “During FY 1976, patents will expire on several high volume products which would then be eligible for inclusion in the MAC program. These products will yield additional savings, but they are not included in the above estimates.”
While the phrasing of these passages may be somewhat inartful, it is clear that the drafters of the two passages contemplated a situation in which the patent holder faced no competition from a licensee. The patented drugs were assumed to be single source drugs. Indeed this assumption is expressed by specific language in those passages indicating that the orginator of the patent was afforded “protection from competition.” When a patent holder licenses a patented drug, it waives its right, subject to the terms of the license, to invoke the patent laws to prohibit the licensee from competing.
These two passages in the Statement do not address the situation of a patent holder who opens up the market for its patented product to competition, by for example, licensing the drug for sale by another manufacturer. When a rational patent holder chooses to license its patented product, its research and development costs presumably are recouped, at least in part, by the royalties paid to it by the licensee pursuant to a licensing agreement. Nothing in these two brief passages of the Statement discussing the economic effects of the MAC program on research and development expenditures and anticipated savings from the MAC program suggests that the MAC regulation was not intended to allow the government to act as any other prudent and informed consumer when the patent holder has created competition for its product and thereby rendered the product a multiple source drug.
Thus, even if this court were required to defer to the Inflation Impact Statement in construing the clear language of the MAC regulation, the Statement does not interpret the regulation to exclude patented drugs from the MAC program.
IV. Application of the MAC Regulation to Doxepin Does Not Violate Patent Laws
In addition to charging that the MAC regulation does not apply to patented drugs, Pfizer suggests that the Department’s application of the MAC regulation to the patented drug Doxepin is unlawful because it diminishes Pfizer’s lawful patent protection. This contention is erroneous. U.S. patent laws grant a patentee “the right to exclude others from making, using or selling the invention throughout the United States” for a period of 17 years.
The patent laws provide, in addition, that a patent holder may relinquish or diminish its right to exclude competitors by granting licenses to others for the marketing of its patented product. Federal law allows a patent holder to assign or license a patent.
The protections afforded patentees, however, do not include the right to prevent consumers from making rational purchases when the patent holder itself has
In the instant case, the MAC regulation establishes a procedure whereby the federal government can act as a rational and prudent consumer when making expenditures for prescription drugs. As applied to Doxepin HC1, the MAC regulation enables the government to purchase Doxepin at a cost based on the lowest price widely and consistently available when the patent holder has created competition by licensing its product. The application of the MAC regulation to Doxepin does not unlawfully impair Pfizer’s patent protection.
V. Conclusion
The plain meaning of the MAC regulation and its express purpose make clear that the regulation applies to multiple source drugs which are patented. This interpretation of the regulation is not contradicted by the Inflation Impact Statement issued by the Department at the time the MAC regulation was initially proposed. Furthermore, application of the MAC regulation to the patented drug Doxepin HC1 does not impair Pfizer’s legal patent protection. Accordingly, the judgment of the district court is reversed. Because the district court granted summary judgment on only one of Pfizer’s counts, we remand the case to the district court for its consideration of Pfizer’s other claims.
So ordered.
. Pfizer Inc. filed two complaints in the district court challenging the MAC limits set for Doxepin HC1 for different sets of capsule dosages. Summary judgment was entered in both cases. See No. 79-0185, D.D.C. 29 June 1983 (mem.); No. 79-3399, D.D.C. 29 June 1983; Joint Appendix (J.A.) at 10, 16, 16a. These cases were consolidated on appeal.
. 42 U.S.C. §§ 1395f(b), 1395x(v)(1)(A), 1396a(a)(30) (1976 & Supp. V 1981).
. Id. § 1395x(v)(1)(A).
. In 1979 HEW was redesignated the Department of Health and Human Services ("HHS"). See 20 U.S.C. § 3508 (1982). References to “the Department” are to HEW prior to the redesignation and to HHS after the redesignation.
. Since their issuance in 1975 the regulations have been partially amended. The current regulations are described herein. See 45 C.F.R. § 19.1 (1983).
. See id. § 19.3.
. See id. § 19.5.
. See id. §§ 19.5(a), 19.4(a) (emphasis added).
. See id. § 19.2(d).
. See id. § 19.5(c) (emphasis added). If the drug is not available at the same lowest unit price in some locations, the Board is directed to make a separate unit pi ice determination for those locations. See id.
. See id. § 19.5.
. See 43 Fed.Reg. 36,698 (1978).
. See J.A. at 11.
. See 43 Fed.Reg. 57,972 (1978).
. See 43 Fed.Reg. 57,974 (1978).
. See 44 Fed.Reg. 50,651 (1979).
. See J.A. at 28, 73.
. See Complaint in No. 79-0185, J.A. at 39-56; Memorandum Opinion, D.D.C. 29 June 1983, J.A. at 2-3.
. See supra note 1, J.A. at 16, 16a.
. See, e.g., Morton v. Ruiz, 415 U.S. 199, 235, 94 S.Ct. 1055, 1074, 39 L.Ed.2d 270 (1974); Arizona Grocery Co. v. Atchison, Topeka & Santa Fe Railway Co., 284 U.S. 370, 389-90, 52 S.Ct. 183, 186, 76 L.Ed. 348 (1932).
. See 45 C.F.R. § 19.5(a) (1983).
. See id. § 19.2(d).
. The MAC limit established for a particular drug does not apply, however, if the prescriber certifies that a particular brand of the drug is medically necessary for a patient. See 45 C.F.R. § 19.3(a)(3) (1983).
. 39 Fed.Reg. 40,302 (1974).
. Id. at 40,302-03.
. Id. at 40,303 (emphasis added).
. 40 Fed.Reg. 32,288 (1975) (emphasis added).
. 45 C.F.R. §§ 19.3, 19.5(a) (1983).
. See 40 Fed.Reg. 32,287 (1975) ("The Secretary advises that the Department has prepared a statement which addresses the issues raised in these comments.").
. 380 U.S. 1, 16 (1965) (emphasis added) (quoting Bowles v. Seminole Rock & Sand Co., 325 U.S. 410, 414, 65 S.Ct. 1215, 1217, 89 L.Ed. 1700 (1945)).
. 562 F.2d 1310, 1316 (D.C.Cir.1977).
. 454 U.S. 27, 37, 102 S.Ct. 38, 44, 70 L.Ed.2d 23 (1981).
. 323 U.S. 134, 140, 65 S.Ct. 161, 164, 89 L.Ed. 124 (1944). See Adamo Wrecking Co. v. United States, 434 U.S. 275, 287 n. 5, 98 S.Ct. 566, 574 n. 5, 54 L.Ed.2d 538 (1978); Batterton v. Francis, 432 U.S. 416, 425-26 n. 9, 97 S.Ct. 2399, 2405-06, 53 L.Ed.2d 448 (1977).
. See 40 Fed.Reg. 32,303 (1975); Executive Order 11,821, 3 C.F.R. 926 (1974). The Statement may also be part of the Department’s general statement of the regulation’s basis and purpose. See American Medical Association v. Mathews, 429 F.Supp. 1179, 1187-88 n. 6 (N.D.Ill.1977); 5 U.S.C. § 553(c) (1982).
. See supra note 26 (emphasis added).
.See Inflation Impact Statement on C.F.R. Title 45, Subtitle A, Part 19 — Limitations on Payment or Reimbursement for Drugs, J.A. at 123-24.
. See id. at 136.
. United States v. Studiengesellschaft Kohle, m.b.H., 670 F.2d 1122 (D.C.Cir.1981).
. See J.A. at 127, 134, 157.
. In addition, Appellee Pfizer, in its brief quotes a single sentence from a brief apparently filed by the Department in another case before the District Court for the Northern District of Illinois, in an attempt to support its contention that the MAC regulation does not apply to patented drugs. Even if it were proper for this court to defer to a single sentence written by the Department’s counsel in the context of litigation before another court, we do not read the sentence as construing the MAC regulation to exclude multiple source drugs that are patented. See Brief of Appellee Pfizer Inc. at 3.
. 35 U.S.C. § 154 (1982).
. 395 U.S. 100, 135, 89 S.Ct. 1562, 1582, 23 L.Ed.2d 129 (1969).
. 316 F.2d 401, 409 (1963).
. 35 U.S.C. § 261 (1982).
. See Zenith Radio Corp. v. Hazeltine, 395 U.S. 100, 135-36, 89 S.Ct. 1562, 1582-83, 23 L.Ed.2d 129 (1969).
. See, e.g., United States v. General Electric, 272 U.S. 476, 47 S.Ct. 192, 71 L.Ed. 362 (1926).
. See supra TAN 18.