Paleski

Plaintiff, a beneficiary of the California Medical Assistance Program (Medi-Cal), has AIDS (acquired immune deficiency syndrome). He depends upon Medi-Cal for prescription drugs. Plaintiff’s physician diagnosed him with wasting syndrome, a disorder related to HIV (human immunodeficiency virus) that causes the body to use lean body mass rather than fat as an energy source. Plaintiff’s physician prescribed a drug specifically approved for the treatment of HIV-related wasting.

After an initial course of treatment, which proved beneficial, plaintiff’s physician concluded plaintiff was still suffering from wasting syndrome and prescribed the drug for an additional period. The State Department of Health Services (Department), which administers Medi-Cal, disagreed with the physician’s determination and denied the request based on its published drug criteria. Several weeks later, a second prescription request was submitted to the Department and also denied.

Plaintiff filed a petition for a writ of mandate in the trial court, challenging the Department’s published drug criteria on the grounds: (1) they had not been promulgated in accordance with the Administrative Procedure Act…