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AMERICAN HOSPITAL ASSN. v. BECERRA 

Opinion of the Court 

reimbursement  rates  by  hospital  group  thus  depends  on 
whether  HHS  has  obtained  acquisition  cost  survey  data
from  hospitals.  The  statute  expressly  authorizes  HHS  to 
vary rates by hospital group if HHS has conducted such a 
survey.  But the statute does not authorize such a variance 
in  rates  if  HHS  has  not  conducted  a  survey.    Cf.  Babb  v. 
Wilkie, 589 U. S. ___, ____ (2020) (slip op., at 12); Sandoz 
Inc. v. Amgen Inc., 582 U. S. ___, ___ (2017) (slip op., at 16); 
Russello v. United States, 464 U. S. 16, 23 (1983). 

The statute thus protects all hospitals by imposing an im-
portant procedural prerequisite—namely, a survey of hos-
pitals’ acquisition costs for prescription drugs—before HHS 
may  target  particular  groups  of  hospitals  for  lower  reim-
bursement  rates.  The  survey  allows  the  agency  to  deter-
mine whether there is in fact meaningful, statistically sig-
nificant variation among hospitals’ acquisition costs.  The 
data  regarding  variation  in  hospitals’  acquisition  costs  in 
turn help HHS determine whether and how much it should
vary the reimbursement rate among hospital groups.  See 
§§1395l(t)(14)(D)(iii)–(iv).  But absent that survey data, as 
not  make 
Congress 
“billion-dollar  decisions  differentiating  among  particular 
hospital groups.”  967 F. 3d, at 837 (Pillard, J., dissenting).
In this case, all agree that HHS did not conduct a survey
of hospitals’ acquisition costs.  See, e.g., 82 Fed. Reg. 52501.
HHS nonetheless varied the rates by hospital group, fixing
a substantially lower reimbursement rate for 340B hospi-
tals than for non-340B hospitals.

determined,  HHS  may 

Under the text and structure of the statute, this case is 
therefore straightforward: Because HHS did not conduct a
survey of hospitals’ acquisition costs, HHS acted unlawfully 
by reducing the reimbursement rates for 340B hospitals.

HHS maintains that there is more to the case than that 
straightforward analysis would suggest.  HHS emphasizes 
that even when it does not conduct a survey of acquisition
costs  and  thus  is  required  to  employ  option  2  (based  on