Cite as: 538 U. S. 644 (2003)
Thomas, J., concurring in judgment
place on prescription drug coverage under Medicaid. Importantly, it says that "[a] State may subject to prior authorization any covered outpatient drug." § 1396r-8(d)(1)(A). The only stricture placed on a prior authorization program is compliance with certain enumerated procedures, § 1396r- 8(d)(5). Undoubtedly, the "purpose" of § 1396r-8(d)(1) is its effect—to grant participating States the authority to subject drugs to prior authorization subject only to the express limitations in § 1396r-8(d)(5).
This reading of the Medicaid Act's prior authorization provisions is confirmed by its near-neighbors. Section 1396r- 8(d) allows States to exclude or further restrict coverage (beyond prior authorization) of a "covered outpatient drug" if "the prescribed use is not for a medically accepted indication," § 1396r-8(d)(1)(B)(i), or if the drug or use is on a list specified in § 1396r-8(d)(2). That list includes, for example, prescriptions for "anorexia . . . or weight gain," § 1396r- 8(d)(2)(A), and "cosmetic purposes or hair growth," § 1396r- 8(d)(2)(C), as well as all barbiturates, § 1396r-8(d)(2)(I). Furthermore, under § 1396r-8(d)(6), "[a] State may impose limitations, with respect to all such drugs in a therapeutic class, on the minimum or maximum quantities per prescription . . . if such limitations are necessary to discourage waste . . . ." This fine-tuning of a State's ability to restrict drug coverage beyond prior authorization stands in stark contrast to the broad authority granted to States to impose prior authorization. Indeed, these provisions confirm that when Congress meant to impose limitations on state authority in this area it did so explicitly.
The authority to entirely exclude coverage of certain drugs or uses, for any reason,1 again illustrates the futility
1 Neither the plurality nor the opinion concurring in part and dissenting in part (hereinafter dissent) suggests that there is any purpose-based limitation on a State's authority under § 1396r-8(d)(2). Nor can they. The restrictions enable States to make value, rather than cost or care, judg-
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