govinfo:USCOURTS-dcd-1_26-cv-01081-0

UNITED STATES DISTRICT COURT 
FOR THE DISTRICT OF COLUMBIA 
 
SMART APPROACHES TO 
MARIJUANA, et al., 
 
Plaintiffs, 
 
v. 
ROBERT F. KENNEDY, JR., Secretary of 
Health and Human Services, et al., 
 
Defendants. 
 
 
 
 
Case No. 1:26-cv-1081 (TNM) 
 
MEMORANDUM OPINION 
 In a founding era exchange about agricultural affairs, Gouverneur Morris commented to 
Thomas Jefferson that hemp “is of Necessity to the Commerce and Marine in other Words to the 
Wealth and Protection of the Country.” Enclosure: Notes respecting Tobacco (March 16, 1791), 
in 19 Papers of Thomas Jefferson 576–578 (Boyd ed. 1974). Though the cannabidiol product 
known as “hemp” no longer forms part of the backbone of American commerce, its role in 
American medicine has grown large enough to prompt regulatory action. 
 This case concerns recent developments on that front. In April 2026, the Center for 
Medicare and Medicaid Innovation (“CMMI”) implemented a new, optional pathway for 
qualifying Medicare providers to furnish qualifying beneficiaries with hemp. That decision 
drove many challengers—spanning from patients and providers to several organizations to 
pharmaceutical companies—to this Court. They seek a preliminary injunction to put the new 
pathway on hold. In support, Plaintiffs mount a series of claims under the Administrative 
Procedure Act (“APA”) and the Constitution, arguing that the pathway conflicts with federal law 
and that CMMI failed to follow required procedures in creating it. 

2 
 But the Court need not address those question to resolve this dispute. Plaintiffs, though 
numerous, have not established standing to bring this case. Each claims an injury too abstract or 
too remote to open the courtroom doors. The Court will thus grant Defendants’ motion to 
dismiss and deny Plaintiffs’ motion for a preliminary injunction as moot. 
I. 
For more than a decade, the federal government has been in the business of testing new 
ways to serve Medicare beneficiaries. It began that effort in 2010 when Congress, through 
§ 1115A of the Social Security Act, established CMMI within the Centers for Medicare & 
Medicaid Services (“CMS”). See 42 U.S.C. § 1315a. As § 1115A instructs, CMMI tests 
“innovative payment and service delivery models” that aim to “reduce program expenditures 
. . . while preserving or enhancing the quality of care” for Medicare and Medicaid beneficiaries. 
See id. 
 In creating CMMI, Congress delegated authority to the Secretary of Health and Human 
Services (“HHS”) to design and implement these payment models. See id. The Secretary may 
select models, determine their elements and parameters, set their scope and duration, and choose 
their participants. Id. § 1315a(b). CMMI has tested numerous payment models since its 
creation. Fishman Decl. ¶ 5, ECF No. 30-2. Many models or components of them—like those at 
issue—are voluntary. Id. Eligible healthcare providers can choose to opt into them by signing a 
participation agreement with CMS. Id.; Am. Compl. ¶ 81, ECF No. 25. These participation 
agreements define model requirements including quality benchmarks, spending targets, reporting 
obligations, beneficiary engagement incentives, payment methodologies, and other conditions. 
Fishman Decl. ¶ 5; see Am. Compl. ¶ 83. Over its sixteen-year existence, CMMI has never 

3 
conducted a notice-and-comment rulemaking for a voluntary model component. Fishman Decl. 
¶ 5; see Hr’g Tr. at 13:23–14:25. 
 In March 2026, CMS announced a new voluntary model component to participants in 
three existing CMMI models. This component, called the Substance Access Beneficiary 
Engagement Incentive (“BEI”) allows providers who opt in to consult with eligible patients 
about the possible use of certain hemp products to address their health needs. Am. Compl. ¶ 83; 
Fishman Decl. ¶ 8. If appropriate, those healthcare providers may furnish beneficiaries with up 
to $500 of hemp products annually. Am. Compl. ¶ 83. 
 A law unrelated to CMMI model mechanics lets the agency treat hemp this way. Hemp, 
after all, is a marijuana derivative. And marijuana is a Schedule I substance that is generally 
illegal under federal law. 21 U.S.C. § 812(c)(10).
1 But the Agriculture Improvement Act of 
2018 (“2018 Farm Bill”) drew a statutory line between hemp and marijuana. Congress defined 
“hemp” as “the plant Cannabis sativa L. and any part of that plant, including the seeds thereof 
and all derivatives, extracts, cannabinoids, isomers, acids, salts, and salts of isomers,” with “a 
delta-9 tetrahydrocannabinol concentration of not more than 0.3 percent on a dry weight basis.” 
7 U.S.C. § 1639o(1). At the same time, it amended the Controlled Substances Act to exclude 
hemp from the definition of “marihuana.” See Agriculture Improvement Act of 2018, Pub. L. 
No. 115-334, § 12619, 132 Stat. 4490, 5018. Put together, these features mean that hemp is not a 
 
1 Recent initiatives have carved out exceptions to marijuana’s Schedule I status. See Schedules 
of Controlled Substances: Rescheduling of Food and Drug Administration Approved Products 
Containing Marijuana From Schedule I to Schedule III, 81 Fed. Reg. 22714 (April 28, 2026) (to 
be codified at 21 C.F.R. pts. 1300, 1301, 1308, and 1312) (placing certain FDA-approved 
products containing marijuana in Schedule III). While marijuana otherwise remains a Schedule I 
substance, initiatives to more broadly reschedule it are under way. See Schedules of Controlled 
Substances: Rescheduling of Marijuana, 91 Fed. Reg. 22777 (April 28, 2026). 

4 
Schedule I controlled substance and is not illegal under federal law. See DeLorean 88 LLC v. 
District of Columbia, 806 F. Supp. 3d 49, 54–55 (D.D.C. 2025). 
 This statutory and regulatory background sets the scene for this dispute. Plaintiffs 
include one patient, one physician, eleven organizations, and a pharmaceutical company and its 
subsidiaries. Am. Compl. ¶¶ 6-21. All oppose the BEI for many reasons. The Court briefly 
describes each Plaintiff below. 
Individual Plaintiffs. The first individual Plaintiff is David Evans, a 78-year-old 
Medicare beneficiary who receives care from Hopscotch Primary Care, which participates in a 
CMMI model eligible for the BEI (though it has not opted into the BEI). Evans Decl. ¶¶ 4, 6, 
ECF No. 28-6. Evans is “opposed to expanded access to cannabis and hemp-derived products” 
and does “not want such products provided by or through [his] Medicare provider.” Id. ¶ 7. 
Next is physician Dr. Kenneth Finn, who practices pain medicine in Arizona. Finn Decl. 
¶ 3 ECF No. 28-7. While he does not claim to participate in any CMMI model that could opt 
into the BEI, he fears he will be asked to participate in the BEI, and he expects the BEI to result 
in increased emergency room visits and more malpractice liability. Id. ¶¶ 17–19. 
Organizational Plaintiffs. Turning to the eleven organizational Plaintiffs, each stands on 
similar footing. None participates in the BEI or has members that do. See generally Am. 
Compl. ¶¶ 6–16. Rather, each claims the BEI impeded their programming. Because these 
Plaintiffs’ operations differ, a description of each is in order. 
Many organizational Plaintiffs work in the drug-education and safety realm. Smart 
Approaches for Marijuana (“SAM”), for instance, does “education and advocacy regarding the 
public health and safety impact of marijuana and cannabis policy.” Niforatos Dec. ¶ 5, ECF No. 

5 
28-1. To support its mission, SAM runs “public health education campaigns” and “research and 
policy analysis programs.” Id. ¶ 6. 
Cannabis Industry Victims Educating Litigators (“CIVEL”) has a similar purpose. Am. 
Compl. ¶ 7. It educates “legal professionals and the public about the harms caused by the 
cannabis industry.” Id. CIVEL does so through “legal education seminars, victim assistance 
programs, and community outreach.” Id. 
Americans Against Legalizing Marijuana (“AALM”) is likewise “dedicated to providing 
information on the harms of marijuana to individuals and our country,” id. ¶ 8, and it likewise 
runs “education programs” and “public awareness campaigns,” and supports doctors and lawyers 
in these fields, id. 
North Carolinians Against Legalizing Marijuana (“NCALM”) opposes the “legalization 
of medical hemp-derived” products. Id. ¶ 9. Its activity includes “legislative advocacy, public 
education campaigns, and policy analysis regarding the risks of marijuana.” Id. 
Cannabis Industry Victims Seeking Justice (“CIVSJ”) seeks to hold “the marijuana 
industry legally accountable to its victims and to provide advocacy services to the many victims 
of the cannabis industry.” Id. ¶ 11. It runs “victim advocacy” programs, “legal accountability 
initiatives, and public education” programs to do so. Id. 
Cannabis Impact Prevention Coalition, LLC (“CIPC”) strives to “prevent the negative 
social, health, public safety, and environmental impacts of marijuana.” Am. Compl. ¶ 10. CIPC 
also operates “public education, community outreach, and policy advocacy” programs to further 
its mission. Id. 
Drug Free America Foundation (“DFAF”) is a “drug prevention and policy organization” 
that seeks to “prevent drug use and promote sustained recovery.” Ronshausen Decl. ¶ 5, ECF 

6 
No. 28-2. It serves its aims through “education programs, student assistance initiatives, 
community outreach,” and similar activities. Id. ¶ 6. 
Save Our Society From Drugs (“SOS”) is a nonprofit that promotes “sound drug laws and 
policies that will reduce illegal drug use, drug addiction and drug-related illness and death.” Id. 
¶ 7. It does so through “education programs, public awareness campaigns, community 
intervention initiatives . . . and related operational activities.” Id. ¶ 8. 
Drug Watch Internation (“DWI”) is similar. It promotes “healthy drug-free cultures” and 
advocates “for the prohibition of and abstinence from all drugs,” and “oppose[s] the legalization 
of drugs prohibited by national and international laws.” Coleman Decl. ¶ 4, ECF No. 28-3. 
DWI researches and analyzes “international drug policy” and consults government agencies. Id. 
¶ 5. 
Some organizations do more than oppose cannabis legalization laws. Hillsborough 
County Anti-Drug Alliance (“HCADA”), for instance, supports law enforcement, the courts, 
prevention agencies, and substance abuse treatment providers through substance abuse education 
activities. Snelling Decl. ¶ 4, ECF No. 28-4. Those activities span from addressing alcohol 
issues on college campuses to work on “smoking effects on pets.” Id. ¶ 5. Cannabis awareness 
fall within that realm. Id. 
Illinois Family Institute (“IFI”) also has a broad reach. This nonprofit aims to advance 
public policy initiatives consistent with “Judeo-Christian teachings and traditions.” Valente 
Decl. ¶ 4, ECF No. 28-5. In line with that goal, IFI educates “Christians and the general public 
on matters of moral concern,” such as “opposition to further access to drugs, including cannabis- 
and hemp-derived products.” Id. 

7 
This legion of organizations opposes the BEI for similar reasons. Each claims the BEI 
required them to divert resources from their regular programming. Am. Compl. ¶¶ 6–16. Some 
say they had to use those resources to research and oppose the BEI. See id. Some say those 
resources went to educating the public about the BEI. See id. Some do not specify where the 
resources went. Am. Compl. ¶¶ 8, 10–11, 13. Whatever the variation, the theme is the same: the 
BEI allegedly stood in the way of these organizations’ usual work. 
Pharmaceutical Company Plaintiff. Last is pharmaceutical company MMJ International 
Holdings, Inc. and its subsidiaries (collectively, “MMJ”). MMJ develops cannabinoid 
therapeutics through FDA’s “botanical drug development framework.” Boise Decl., ¶ 4, ECF 
No. 28-8. Over the past eight or so years, MMJ has invested over $10 million into this work. Id. 
¶ 43. That capital and labor has gone toward a variety of efforts, including “regulatory strategy, 
clinical development planning, chemistry, manufacturing . . . and Investigational New Drug 
(“IND”) submissions for cannabinoid-based treatments targeting Huntington’s disease and 
multiple sclerosis.” Id. ¶ 4. 
Many moving parts make up MMJ’s work. One subsidiary, for instance, sought 
registration with the U.S. Drug Enforcement Administration to bulk manufacture marijuana’s 
active ingredient for use in FDA-authorized clinical trials. Id. ¶ 6. That application remains 
pending, and no clinical trials have started. Id. ¶¶ 6, 13. Another subsidiary, meanwhile, 
obtained a “Schedule I analytical laboratory registration” from the DEA to support MMJ’s 
cannabis research. Id. ¶¶ 8, 12. MMJ has also “initiated formal regulatory engagement” with 
FDA by submitting “Investigational New Drug” requests to support its Huntington’s disease 
program and multiple sclerosis program. Id. ¶ 20. Since then, FDA granted has MMJ “Orphan 

8 
Drug Designation” for its treatment targeting Huntington’s disease. Id. ¶ 21. That designation 
recognizes that MMJ’s treatment targets a rare disease or condition. See 21 C.F.R. § 316.23. 
MMJ’s efforts have yet to see fruition. MMJ has evaluated seven prototype formulations 
of its product and scaled one of them for production. Boise Decl. ¶ 23. In February 2025, 
however, FDA issued a “Full Clinical Hold letter,” halting MMJ’s multiple sclerosis efforts. Id. 
¶¶ 20, 25. Though none of its products are ready for public use, see generally id., MMJ 
challenges the BEI for allowing the “distribution of hemp-derived cannabinoid products outside 
the FDA drug approval framework” while MMJ remains “subject to full pharmaceutical 
regulatory requirements.” Id. ¶ 36. 
* * * 
Together, Plaintiffs turned to this Court to challenge the BEI a few days before it was set 
to go into effect. They sue HHS, CMS, HHS Secretary Robert F. Kennedy, Jr., and CMS 
Administrator Mehmet Oz (collectively, “the Secretary”). Plaintiffs bring a variety of claims 
under the Administrative Procedure Act (“APA”) and the Constitution. To sum up their 
grievances, Plaintiffs claim that, in implementing the BEI, the Secretary: (1) violated the APA’s 
notice-and-comment requirements; (2) acted arbitrarily and capriciously by failing to consider 
relevant evidence and by changing courses from his prior positions; (3) exceeded CMS’s 
statutory authority; (4) conflicted with the 2026 Agriculture Appropriations Act; (5) denied MMJ 
its Fifth Amendment equal protection guarantee
2; and (6) denied all Plaintiffs procedural and 
substantive due process in violation of the Fifth Amendment. Am. Compl. ¶¶ 159, 162, 163, 
178, 183, 191, 193. 
 
2 Though part of the Fourteenth Amendment, the Equal Protection Clause applies to the District 
of Columbia through the Due Process Clause of the Fifth Amendment. Bolling v. Sharpe, 347 
U.S. 497, 499 (1954). 

9 
Upon filing a Complaint, Plaintiffs moved for a temporary restraining order to stop the 
BEI’s impending implementation. Emergency Mot. for TRO, Mot. for Prelim. Inj., Mot. to Stay, 
ECF No. 3. The Court denied that request. Order, March 31, 2026, ECF No. 14. After 
amending their initial Complaint, see Am. Compl., Plaintiffs sought a preliminary injunction and 
stay. Mot. for Prelim. Inj., Mot. to Stay (“Pls.’ Mot.”), ECF No. 27. The Secretary opposes and 
moves to dismiss the case on a variety of grounds. Mot. to Dismiss and Opp’n to Pls.’ Mot. 
(“Defs.’ Mot.), ECF No. 30. These motions are now ripe, and the Court held argument on them. 
See Minute Entry, May 1, 2026. It turns to them now.
3 
At the outset, the Court notes that it need not tackle the bulk of questions that Plaintiffs 
raise in their motions. That is because Plaintiffs’ case suffers from a fatal flaw: the failure to 
establish Article III standing to bring their claims. The Court addresses only this jurisdictional 
hole and will dismiss the entire suit and deny Plaintiffs’ motion for a preliminary injunction as 
moot. 
II. 
To survive a motion to dismiss under Rule 12(b)(1), the plaintiff bears the burden of 
proving that the Court has subject matter jurisdiction to hear his claims. See Arpaio v. Obama, 
797 F.3d 11, 19 (D.C. Cir. 2015). Federal district courts possess limited jurisdiction, and it is 
“presumed that a cause lies outside this limited jurisdiction.” Kokkonen v. Guardian Life Ins. 
Co. of Am., 511 U.S. 375, 377 (1994). Thus, the plaintiff “bear[s] the burden of establishing 
jurisdiction by a preponderance of the evidence.” Yaghoubnezhad v. Stufft, 734 F. Supp. 3d 87, 
95 (D.D.C. 2024). 
 
3 Because an administrative record is unnecessary for the Court resolution of this case, it grants 
the Secretary’s Motion for Relief from Local Civil Rule 7(n)(1), to which Plaintiffs do not 
object. Defs.’ Mot. for Relief from LCvR 7(n)(1), ECF No. 32. 

10 
When evaluating a motion to dismiss under Rule 12(b)(1), the Court must “treat the 
Complaint’s factual allegations as true . . . and must grant plaintiff the benefit of all inferences 
that can be derived from the facts alleged.” Sparrow v. United Air Lines, Inc., 216 F.3d 1111, 
1113 (D.C. Cir. 2000) (cleaned up). But those factual allegations “will bear closer scrutiny in 
resolving a 12(b)(1) motion than in resolving a 12(b)(6) motion for failure to state a claim.” 
Schilling v. Speaker of U.S. House of Reps., 633 F. Supp. 3d 272, 275 (D.D.C. 2022), aff’d sub 
nom. Schilling v. U.S. House of Reps., 102 F.4th 503 (D.C. Cir. 2024). And a court may consider 
documents outside the pleadings to evaluate whether it has jurisdiction. See Jerome Stevens 
Pharms., Inc. v. FDA, 402 F.3d 1249, 1253 (D.C. Cir. 2005). If the Court determines that it 
lacks jurisdiction, it must dismiss the claim or action. Fed. R. Civ. P. 12(b)(1), 12(h)(3). 
One jurisdictional issue proves dispositive—whether Plaintiffs have standing to sue. 
Warth v. Seldin, 422 U.S. 490, 498 (1975). Federal courts “do not possess a roving commission 
to publicly opine on every legal question” and do not “exercise general legal oversight” of 
private parties or the other branches of the federal government. TransUnion LLC v. Ramirez, 
594 U.S. 413, 423–24 (2021). Standing doctrine focuses courts on “matters of a Judiciary 
Nature,” by ensuring that the proper plaintiff sued the proper defendant over an injury a court 
can remedy. Id. at 424 (cleaned up). 
To establish this “irreducible constitutional minimum,” Lujan v. Defs. of Wildlife, 504 
U.S. 555, 560–61 (1992) (cleaned up), a plaintiff must establish that he “has suffered or likely 
will suffer an injury in fact”; “that the injury likely was caused or will be caused by the 
defendant”; and “that the injury likely would be redressed by the requested judicial relief.” FDA 
v. All. for Hippocratic Med., 602 U.S. 367, 380 (2024). At the pleading stage, a plaintiff must 
“clearly allege . . . facts demonstrating each element.” Spokeo, Inc. v. Robins, 578 U.S. 330, 338 

11 
(2016) (cleaned up). And he must do so for each defendant and for each form of relief sought. 
See Davis v. FEC, 554 U.S. 724, 734 (2008). 
A recent case—FDA v. Alliance for Hippocratic Medicine, 602 U.S. 367 (2024)— 
directly relates to several of Plaintiffs’ standing theories and thus deserves a word at the outset. 
In Hippocratic Medicine, a group of pro-life medical associations and several individual doctors 
sued the FDA to challenge its approval of an application for generic mifepristone, an 
abortifacient. Id. at 376. None prescribed, consumed, or manufactured mifepristone. Id. at 386. 
None sponsored a competing drug. Id. And none suffered an injury to property from FDA’s 
actions. Id. Given the attenuation between themselves and mifepristone, plaintiffs mounted 
“several complicated” arguments to establish standing to challenge the drug. Id. None worked. 
The Supreme Court first rejected the individual plaintiffs’ claimed injury to their 
“conscience” because nothing about FDA’s mifepristone approval required those doctors “to 
participate in an abortion or provide” related treatment “over their conscience objections.” Id. at 
386–87. It likewise discounted the individual plaintiffs’ claim that treating patients with 
mifepristone complications would increase “risk of liability suits.” Id. at 390. The causal link 
between FDA’s regulatory actions and that possibility proved too little for standing. Id. The 
medical association plaintiffs fared no better. Even though mifepristone’s approval “caused” 
them to spend considerable time and resources on studying mifepristone and engaging in “related 
public advocacy and education” to the “detriment of other spending priorities,” they too lacked 
standing. As the Supreme Court put it, an organization “cannot spend its way into standing 
simply by expending money to gather information and advocate against the defendant’s action.” 
Id. at 394. At bottom, the Hippocratic Medicine plaintiffs had a sincere objection to FDA’s 

12 
relaxed regulation of mifepristone, but no matter how they framed it, that objection could not 
establish a “justiciable case or controversy.” Id. at 396. 
III. 
 Given the variety of Plaintiffs, this case involves a few different flavors of standing 
analysis. The Court considers each group of Plaintiffs’ standing in turn. 
A. 
Start with the individual Plaintiffs, David Evans and Dr. Kenneth Finn. Both falter at the 
first hurdle, injury-in-fact. A few showings are required for an Article III injury to “screen[] out 
plaintiffs who might have only a general legal, moral, ideological, or policy objection to a 
particular government action.” Hippocratic Med., 602 U.S. at 381. Two pose problems for the 
pair. First, a plaintiff must identify a “concrete” injury, meaning one that is “real and not 
abstract.” Id. Second, a plaintiff must allege that his injury is “actual or imminent, not 
speculative,” meaning that the injury “must have already occurred or be likely to occur soon.” 
Id. Evans and Finn do neither. 
Up first is Evans, who claims that the BEI will harm him in a few ways. He fears that if 
his Medicare provider opts in to the BEI, he will be offered hemp products for his health 
conditions. Evans Decl. ¶¶ 7, 12, ECF No. 28-6. Because Evans opposes expanded access to 
hemp products, that possibility could impair his “healthcare relationship.” Id. More, Evans 
owns a nursing home and fears the nursing home “may be asked to participate in the BEI 
process” now that it is in place. Id. ¶ 11. 
None of these claimed injuries is concrete or imminent. Evans’s healthcare provider has 
not opted into the BEI, and Evans has not alleged that it “imminently” will. Clapper v. Amnesty 
Int’l USA, 568 U.S. 398, 411 (2013); see generally Evans Decl. Even if his provider did, the 

13 
possibility that Evans’s provider would recommend hemp products remains just that: possible, 
not “certainly impending.” Clapper, 568 U.S. at 401. 
In any case, if Evans’s worst-case-scenario—his doctor recommends hemp to him—ca me 
true, Evans would lack a concrete harm. Mere “distress at or disagreement with” his doctor’s 
hemp recommendation would not cut it. See Hippocratic Med., 602 U.S. at 390 n.3. Neither 
does Evans’s fear that, if his provider enrolls in the BEI, and if his provider recommends hemp, 
Evans’s “healthcare relationship” may decline. Evans Decl. ¶ 12. “[C]onjectural” and 
“hypothetical” claims like these do not establish standing. Lujan, 504 U.S. 555 at 560 (cleaned 
up). And to the extent Evans worries that his provider’s recommendation would overcome 
Evans’s will and prompt him to consume hemp despite his objections to it, that prospect is 
especially farfetched. Evans serves as a director or consultant for no less than seven anti-
marijuana organizations (also Plaintiffs here), and he has even published books on the topic. 
Evans Decl. ¶¶ 3, 8. Given his thoughtful, vociferous opposition, Evans’s involuntary use of 
hemp surpasses the realm of hypothetical possibilities. 
The same is true about Evans’s claims linked to his nursing home. It remains unclear 
whether his nursing home qualifies for the BEI, let alone whether it will ever “be asked” to 
participate in the BEI process. Evans Decl. ¶ 11; TransUnion LLC, 594 U.S. at 436–37 
(rejecting the “risk of future harm” that may never “materialize” as sufficient grounds for 
standing). Should that day ever come, Evans may decline to participate. Again, the mere request 
to participate in a program with which Evans “disagree[s]” in not a cognizable harm. 
Hippocratic Med., 602 U.S. at 390 n.3. This theory falls short. 
Similar problems plague Dr. Finn’s standing. He complains that the BEI “requires 
participating physicians” to consider whether patients will benefit from hemp products, yet it 

14 
leaves those physicians without clinical guidelines to inform their hemp determinations. Finn 
Decl. ¶ 13. Absent regulatory guidelines, Finn says he cannot, consistent with his “professional 
obligations,” recommend hemp products in accordance with the BEI, so he anticipates that he 
will lose patients who want them. Id. ¶ 16. He adds that the BEI’s creation of new pathways to 
hemp may result in an “increase in emergency room” visits and may prompt more “malpractice” 
suits by patients who overuse hemp products. Id. ¶¶ 17, 19. 
Finn’s alleged harms are a few layers too speculative to establish standing. He has not 
opted into the BEI and need not opt-in going forward. Nothing thus “requires” him to consider 
whether hemp suits his patients, and there is no sign that reality will change any time soon. Id. 
¶ 13. Finn also fears patient loss from his unwillingness to offer hemp products, but he has not 
lost any patients, so the harm remains “hypothetical.” Lujan, 504 U.S. 555 at 560 (cleaned up). 
Indeed, Finn has not even had a patient request a BEI-related product. See generally Finn Decl. 
Coming from a different angle, Finn also expects more emergency room visits, but none 
has occurred, and he alleges no facts establishing imminent likelihood of such events. Id. ¶ 17. 
In any case, such an increase would not afford him standing. See Hippocratic Med., 602 U.S. at 
391 (rejecting the notion that an “emergency room doctor” would have standing to challenge a 
speed limit increase that may mean “he may have to treat more car accident victims”). 
Similarly, he hypothesizes malpractice suits from hemp “overuse.” Id. ¶ 17. This 
allegation is as speculative as the rest and a notch more confusing. Recall that Finn insists that, 
if he opted into the BEI, he would not recommend hemp products absent regulatory dosing 
guidelines. Id. ¶ 16. If Finn plans to refuse to offer his patients hemp, why would those patients 
sue him for overprescribing it? Finn cannot claim injury from hypothetical harms that have not 

15 
yet resulted (and may never result) from a voluntary program that he has not joined (and likely 
never would). 
B. 
A variety of organizations make up the next batch of Plaintiffs. Groups of this sort can 
establish standing in two ways. First, they can assert “associational standing” on behalf of their 
members. See Hunt v. Wash. State Apple Advert. Comm’n, 432 U.S. 333, 343 (1977). “[A]n 
association has standing to bring suit on behalf of its members when: (a) its members would 
otherwise have standing to sue in their own right; (b) the interests it seeks to protect are germane 
to the organization’s purpose; and (c) neither the claim asserted nor the relief requested requires 
the participation of individual members in the lawsuit.” Id.
4 
Second, they can invoke “organizational standing” to sue on their own behalf. See PETA 
v. U.S. Dep’t of Agric., 797 F.3d 1087, 1093 (D.C. Cir. 2015). Under this avenue, Plaintiffs must 
plausibly allege they suffered an “actual or threatened injury in fact” to their own interests that is 
“fairly traceable to the alleged illegal action and likely to be redressed by a favorable court 
decision.” Food & Water Watch, Inc. v. Vilsack, 808 F.3d 905, 919 (D.C. Cir. 2015). 
 Either way, the Constitution demands “an injury that is actual, imminent, or certainly 
impending.” Viasat, Inc. v. FCC, 47 F.4th 769, 778 (D.C. Cir. 2022). At the motion-to-dismiss 
stage, Plaintiffs must “clearly . . . allege . . . facts demonstrating” that injury. Spokeo, 578 U.S. 
at 338. 
 
4 As this Court has observed before, scholars and jurists have questioned the doctrinal soundness 
of associational standing. See, e.g., Coal. for Humane Immigrant Rts. v. DHS, 780 F. Supp. 3d 
79, 91 n.3 (D.D.C. 2025); Cape Cod Charter Boat Ass’n v. Burgum, 810 F. Supp. 3d 1, 11 n.3 
(D.D.C. 2025). Precedent nevertheless requires the Court to consider the doctrine here. 
 

16 
 No Plaintiff has established standing under either avenue. Start with Plaintiffs who claim 
associational standing. Am. Compl. ¶ 62 (listing nine Plaintiffs who “have associational 
standing”). Attempting to meet the doctrine’s demands, each organizational Plaintiff claiming 
associational standing points to a member they allege would have standing to sue in his own 
right. See id. ¶ 63. To whom do they point? David Evans. Id. (“At least one identified member 
of each of Plaintiff, namely Mr. David Evans, has standing to sue in his own right.”). Because 
Evans lacks an injury-in-fact, and thus standing, see Supra Part III.A, the organizations cannot 
rely on his purported injuries either.
5 
 Turning to organizational standing, Plaintiffs still fall short. No Plaintiff has adequately 
alleged an injury. Food & Water Watch, Inc., 808 F.3d at 919. 
Consider what it takes for an organization to surmount the injury-in-fact hurdle. Because 
mere “frustration of an organization’s objectives is the type of abstract concern that does not 
impart standing,” an organization must show “more” than that for an injury. Id. (cleaned up). 
What suffices? Claims that a defendant’s conduct “perceptibly impaired the organization’s 
ability to provide services” and prompted the organization to use “its resources to counteract that 
harm.” Turlock Irrigation Dist. v. FERC, 786 F.3d 18, 24 (D.C. Cir. 2015) (cleaned up); PETA, 
797 F.3d at 1094. 
To be clear, resource diversion “in response to a defendant’s actions” alone does not 
suffice to show that the defendant’s actions “perceptibly impaired” organizational activity. 
 
5 Plaintiffs note that one Plaintiff (CIVEL) who claims associational standing was “granted 
associational standing” by an administrative law judge (“ALJ”) in a separate matter. Am. 
Compl. ¶ 7. That decision is irrelevant to the Article III standing inquiry. As the ALJ explained 
in CIVEL’s proceeding, “agencies are not limited in this way by Article III” and thus may allow 
individuals to sue “who would not otherwise have standing to seek judicial review of the agency 
action ultimately taken.” Am. Compl., Ex. B. at 3. 

17 
Hippocratic Med., 602 U.S. at 395 (cleaned up); Nat’l Taxpayers Union, Inc. v. United States, 68 
F.3d 1428, 1434 (D.C. Cir. 1995). Rather, an organization must show that the defendant’s 
actions subject it “to operational costs beyond those normally expended” to fulfill its core aims. 
Hippocratic Med., 602 U.S. at 395. In other words, the organization must show that the 
defendant’s conduct has forced it to “expend resources in a manner that keeps [it] from pursuing 
its true purpose[s],” Nat’l Taxpayers Union, Inc., 68 F.3d at 1434, or has “directly affected and 
interfered with” the organization’s “core . . . activities,” Hippocratic Med., 602 U.S. at 395. 
So, for example, the D.C. Circuit found an injury in PETA v. Department of Agriculture, 
797 F.3d 1087 (D.C. Cir. 2015). There, the animal-welfare organization PETA challenged the 
government’s refusal to enforce certain animal welfare regulations of birds. Id. at 1091. The 
government’s non-enforcement meant that it stopped publishing reports PETA had “routinely” 
used to educate the public on the treatment of birds. Id. at 1096. More, the non-enforcement 
prevented PETA from filing formal complaints with the agency to seek redress for avian 
mistreatment. Id. at 1095. Because these changes “shifted to the plaintiff organization the 
burden to investigate and respond to complaints about birds subjected to inhumane treatment, 
and/or to obtain appropriate and necessary relief for these animals,” the Circuit concluded that 
plaintiffs identified a concrete harm. See Ctr. for Biological Diversity v. Dep’t of Interior, 144 
F.4th 296, 315 (D.C. Cir. 2025) (cleaned up); PETA, 797 F.3d at 1091. In that scenario, the 
challenged action posed a “concrete obstacle[]” to the organization’s work. See PETA, 797 F.3d 
at 1092 (cleaned up). 
In contrast, the Circuit rejected an environmental organization’s claimed injury from the 
government’s failure to produce opinions useful to its mission in Center for Biological Diversity 
v. Department of Interior, 144 F.4th 296 (D.C. Cir. 2025). There, an organization challenged the 

18 
Bureau of Land Management’s (“BLM”) decision to grant drilling permits on grounds that it 
failed to comply with laws requiring BLM to consult with certain marine life agencies and write 
a “biological opinion” assessing the permit’s impact on various species. Id. at 300–01. This 
failure, the argument went, deprived the organization of information about the permits’ impact 
on threatened species “that would have otherwise been disclosed in the final biological opinion.” 
Id. at 315. Without it, the organization instead had to “expend resources pursuing Freedom of 
Information Act requests” for the same material. Id. The D.C. Circuit rejected this theory. It 
was not enough for injury that the organization would have to “work harder” to gather 
information helpful to its mission. Id. Unlike PETA, this organization failed to “identify 
programmatic expenditures” it had to make to “fill [a] gap” left open by the agency. Id. 
The same result ensued in Food & Water Watch, Inc. v. Vilsack, 808 F.3d 905 (D.C. Cir. 
2015). There, a food-safety advocacy organization claimed injury from the government’s 
loosening of restrictions on poultry inspection processes. Id. at 910–11, 919. Even though the 
organization alleged that the new regulation meant it would have to “spend resources educating 
its members and the public” about the change, nothing suggested its “organizational activities 
[had] been perceptibly impaired in any way.” Id. at 921. Despite those expenses, the D.C. 
Circuit still held that the organization “alleged no more than an abstract injury to its interests.” 
Id. at 920. 
This case is more like the latter two than the first. No organizational Plaintiff shows 
enough for an injury-in-fact. All claim that they diverted resources in response to the BEI’s 
implementation, but none established that such resource diversion “interfered” with its core 
activities or prevented it from “pursuing its true purpose.” Nat’l Taxpayers Union, Inc., 68 F.3d 
at 1434. Consider SAM. It alleges that the “BEI directly impairs [its] core programmatic 

19 
activities by requiring SAM to redirect staff and resources from its ongoing patient and provider 
education programs to monitor, analyze, and provide direct informational services to its members 
and stakeholders regarding the BEI’s implications for vulnerable seniors, as well as engage in 
this litigation.” Am. Compl. ¶ 6; Niforatos Decl. ¶ 9 (same). 
SAM’s claimed injury has a few problems. First, none of its post-BEI actions harms 
SAM’s mission. To the contrary, monitoring, analyzing, and spreading word about the BEI “are 
a fulfillment of” SAM’s ‘mission.’” Coal. for Humane Immigrant Rts. v. DHS, 780 F. Supp. 3d 
79, 90 (D.D.C. 2025). SAM itself describes its “programmatic activities” as including “research 
and policy analysis” and “public health education campaigns.” Am. Compl. ¶ 6. “[M]onitoring” 
and “analyz[ing]” the BEI, and “provid[ing] direct informational services” about the BEI, as 
SAM claims it now must do, fall comfortably under those research and education umbrellas. Id. 
Second, shifts in SAM’s internal operations do not equate to constitutional injury. SAM 
suggests that even if researching and opposing the BEI falls in line with part of its mission, its 
other activity, like “ongoing patient and provider education programs” took a hit in staff and 
resources for SAM to focus on the BEI. Niforatos Decl. ¶ 9. But “organizations have not 
suffered a concrete injury just because shifts in government policy demand shifts in internal 
operations.” Coal. for Humane Immigrant Rts., 780 F. Supp. 3d at 91; accord Env’t Working 
Grp. v. FDA, 301 F. Supp. 3d 165, 172 (D.D.C. 2018). “If that were the case, an organization 
could claim injury-in-fact nearly any time there was a change in the law relevant to its mission.” 
Coal. for Humane Immigrant Rts., 780 F. Supp. 3d at 91. Standing doctrine thus demands more. 
SAM needed to show that the BEI required “operational costs beyond those normally expended.” 
Nat’l Taxpayers Union, 68 F.3d at 1434. As cannabis-safety organization, sinking costs to 

20 
respond to hemp regulatory activity fall within the “normally expended” realm even if internal 
resources shift in the process. See id. 
Third, SAM’s engagement “in this litigation” does not create an injury. Id. The D.C. 
Circuit has made “clear that an organization’s use of resources for litigation . . . is not sufficient 
to give rise to an Article III injury.” Food & Water Watch, 808 F.3d at 919. Like investing into 
BEI-research over other programming, investing in litigation over other programming will not 
put SAM on stronger footing. 
Other organizational Plaintiffs take a similar approach. CIVEL starts by claiming that the 
BEI requires it to “divert” resources from “victim assistance and legal education programs to 
monitor, analyze, and respond to the BEI and its implications for vulnerable seniors.” Am. 
Compl. ¶ 7. As was true for SAM, that is insufficient for standing. 
CIVEL, though, adds that the BEI will “increase . . . hemp injuries” and thus bring “more 
litigation.” Id. Because CIVEL’s mission includes “educating legal professionals” about 
“cannabis industry” harms, an increase in litigation could bring on more costs. Id. Setting aside 
that CIVEL’s theory requires multiple levels of speculation about injuries hemp may cause, and 
litigation those hypothetical injuries may generate, see Lujan, 504 U.S. 555 at 560, this addition 
leaves CIVEL on no less shaky grounds. Even if CIVEL dedicates more resources “to handle 
those cases,” doing so serves its aim of supporting “legal professionals.” Am. Compl. ¶ 7. More 
work does not amount to injury when CIVEL’s purpose is that very work. See Ctr. for 
Biological Diversity, 144 F.4th at 315. 
Other Plaintiffs fare similarly. DWI claims the BEI “interfered” with its anti-substance 
abuse programming by “requiring diversion of resources” from regular programming to instead 
“collect[] and disseminat[e] information” about cannabis, hemp, and the BEI to his constituents. 

21 
Coleman Decl. ¶¶ 7, 8. What DWI programs supposedly face neglect because of the BEI? 
“[D]rug policy research and analysis” and “public education campaigns” are at the top of the list. 
Id. ¶ 5. But if “collecting and disseminating information” about the BEI and hemp advances 
neither “drug policy research and analysis” nor a “public education campaign[],” one wonders 
what does. Id. ¶¶ 7, 8. If DWI’s less related programming (such as providing “technical 
assistance to government agencies”) was uniquely impaired, DWI has not explained how. See 
id. DWI has no injury-in-fact. 
The list goes on, and the result is the same. See Ronshausen Decl. ¶¶ 10, 12 (claiming 
that because DFAF had to “oppose and counter the BEI,” the BEI caused a “drain on 
organizational resources” from other programs); Snelling Decl. ¶ 8 (HCADA claiming that 
because its members “have spent considerable time on collecting and disseminating” information 
about hemp and the BEI to stakeholders, that the BEI diverted its resources); Valente Decl. ¶ 6 
(IFI claiming that because it had to “oppose the BEI” instead of focus on its “public awareness 
campaigns and educational work,” that the BEI harmed it). 
Some Plaintiffs say even less. AALM, CIPC, CIVSJ, and SOS claim that the BEI has 
interfered with their anti-marijuana missions by “requiring diversion of resources” from their 
drug prevention programs. Am. Compl. ¶¶ 8 (AALM), 10 (CIPC), 11 (CIVSJ), 13 (SOS); 
Ronshausen Decl. ¶ 11 (SOS). But none of these Plaintiffs alleges where those resources went 
instead. They even omit the now-familiar allegation that they diverted resources to “monitor, 
analyze, and respond” to the BEI, cf. Am. Compl. ¶¶ 7 (CIVEL), 6 (SAM), and they provide no 
alternative explanation.
6 
 
6 CIPC also alleges that a New York state court concluded it had standing in a similar case. Am. 
Compl. ¶ 10. That court’s conclusion has no effect on this one’s. “Standing to sue in any Article 

22 
NCALM charts its own path but arrives at the same destination. It alleges that the BEI 
directly interferes with its activities “beyond” its “issue-advocacy or mission” because the BEI 
“authorizes the distribution” of non-FDA approved hemp products, which is “the very outcome 
NCALM’s” anti-drug “programs are designed to prevent.” Id. ¶ 9. Fighting this supposed 
harm—a policy outcome antithetical to NCALM’s policy goals—is not “beyond” NCALM’s 
mission. It lies at the center of the mission. See Food & Water Watch, Inc., 808 F.3d at 919. 
Implementing a program that NCALM opposes does injure it. 
No authority Plaintiffs cite undermines this conclusion. They point to Abigail Alliance 
for Better Access to Developmental Drugs v. Eschenbach, 469 F.3d 129 (D.C. Cir. 2006). But in 
that case, a patient advocacy organization challenged an FDA policy that directly denied its 
members’ access to certain drugs. Id. at 132–33. 
They also tout Havens Realty Corp. v. Coleman, 455 U.S. 363 (1982), the outermost 
boundary of the Court’s organizational jurisprudence. See Hippocratic Med., 602 U.S. 396 
(describing Havens as “an unusual case,” and noting “this Court has been careful not to extend 
the Havens holding beyond its context.”). But in Havens, the defendant’s false information 
directly impaired the organization’s ability to accurately counsel the people it served. 455 U.S. 
at 374–75; see also United States v. Texas, 173 F.4th 659, 666 (5th Cir. 2026) (en banc) 
(rejecting a legal advocacy group’s invocation of a Havens standing theory where it diverted 
resources in its work opposing a Texas law). Unlike those cases, Plaintiffs have not 
distinguished themselves as organizations “with a direct stake in the outcome of a litigation.” 
 
III court is, of course, a federal question which does not depend on the party’s prior standing in 
state court.” Phillips Petroleum Co. v. Shutts, 472 U.S. 797, 804 (1985). 
 

23 
United States v. Students Challenging Regul. Agency Procs., 412 U.S. 669, 689 n.14 (1973). 
They thus lack standing. 
C. 
 Next up is the pharmaceutical company MMJ, which pursues a different standing 
theory—competitor standing. As MMJ sees matters, the BEI “expands the competitive 
landscape by creating a federally supported pathway for non-FDA-approved cannabinoid 
products to reach Medicare beneficiaries—the very patient population” that MMJ’s “therapies 
would target.” Am. Compl. ¶ 41. More simply, because the BEI creates new ways for 
healthcare providers to get their patients hemp products, MMJ claims the BEI increases its 
competition. 
Parties may indeed challenge an agency action that “allow[s] increased competition 
against” them. PSSI Glob. Servs., LLC v. FCC, 983 F.3d 1, 11 (D.C. Cir. 2020) (cleaned up). 
To prevail with this theory, the party claiming standing must be a “direct and current competitor 
whose bottom line may be adversely affected by the challenged government action.” New World 
Radio, Inc. v. FCC, 294 F.3d 164, 170 (D.C. Cir. 2002). MMJ struggles with the first part of that 
requirement— establishing itself as a direct and current competitor—because it has no sense of 
when or even if it will begin competing with hemp-sellers for Medicare beneficiaries. 
As an illustration of what suffices for a “current” competitor, take Associated Gas 
Distributors v. FERC, 899 F.2d 1250, 1259 (D.C. Cir. 1990). There, a group of local gas 
distribution companies challenged a FERC decision that eliminated multiple restrictions on gas 
sales and gas transportation. Id. at 1256, 1258. The distributors established standing by arguing 
that the “newly authorized transactions” meant they “may lose business” to other distributors, 
who could enter the market more easily. Id. at 1258. The D.C. Circuit accepted that argument, 

24 
explaining that the “broadening” of gas sales and transportation “authorizations” opened the way 
for others “to invade the core markets” of these distributors. Id. (cleaned up). It rejected the 
notion that the distributors’ “fear” of competition was too speculative for standing. Id. at 1258–
59. Even though a “specific” transaction had not yet “hurt” the distributors “competitively,” id. 
at 1259, they currently operated in the market, new distributors had already tried to enter their 
field, and FERC’s decision removed further barriers for new competition, id. at 1258–59. All of 
this meant the gas distributors faced “clear and immediate” potential for competition. Id. That 
sufficed for standing. 
Now for a plaintiff that did not meet the bar, consider PSSI Global Services LLC v. FCC, 
983 F.3d 1 (D.C. Cir. 2020). There, three “small satellite operators” challenged an FCC order 
that promised certain payments to large satellite operators who transitioned their services to a 
new frequency band quickly. Id. at 5–6, 11. The small satellite operators claimed the FCC’s 
payments to larger operators imposed competitive injuries on them. Id. at 11. Despite its 
ostensible economic logic, the D.C. Circuit rejected this theory. Id. The small satellite operators 
“d[id] not directly and currently compete” with the large satellite operators. Id. At that time, the 
small satellite operators provided services “almost exclusively” outside the United States and had 
taken only a “few steps to develop any United States markets.” Id. While the Circuit recognized 
that it “may take time to develop new business” in the United States, it still rejected the claim 
because “competitor standing requires actual participation in the relevant market.” Id. 
The same was true in New World Radio, Inc. v. FCC, 294 F.3d 164 (D.C. Cir. 2002). In 
that case, New World Radio, a licensee of a Washington, D.C., radio station, claimed a 
“competitive injury” from the FCC’s decision to renew Birach Broadcasting Corporation’s 
broadcasting license for a Maryland city. Id. at 168–69, 171. Even though the two entities 

25 
operated in different geographic markets, New World argued that Birach’s “past attempts to 
relocate” a radio station to the D.C. area suggested that it would do so again. Id. at 172. That 
possibility, New World continued, meant that the FCC’s license renewal increased the chances 
of more competition for New World. Id. The D.C. Circuit disagreed. It explained that, despite 
Birach’s “apparent desire to compete in the Washington, D.C. market, New World’s ‘chain of 
events’ injury [was] too remote to confer standing.” Id. Indeed, because Birach’s market 
presence in Washington depended on the “independent actions of third parties,” the court could 
not “simply acknowledge a chain of causation firmly rooted in the basic law of economics” and 
thus rejected New World’s argument. Id. (cleaned up). 
 By those lights, MMJ is not a direct and current competitor with anyone selling hemp to 
Medicare beneficiaries. In short, MMJ has no product on the Medicare-beneficiary market and 
no sense of when it may. Recall where MMJ stands. MMJ researches and develops 
“cannabinoid-based treatments targeting Huntington’s disease and multiple sclerosis.” Boise 
Decl. ¶ 4. As part of that effort, MMJ has “submitted DEA applications to import and 
manufacture marijuana” to “eventually” conduct “FDA-approved clinical trials.” Id. ¶ 13. The 
DEA has yet to issue a final determination on MMJ’s manufacturing registration. Id. ¶ 19. MMJ 
has no sense of when that may occur. See generally id. 
MMJ also engaged with FDA as part of its effort to get its cannabidiol drug to the clinical 
trial stage. In 2018, MMJ submitted Pre-Investigational New Drug meeting requests for its 
treatments. Id. ¶ 20. Two years later, FDA granted MMJ “Orphan Drug Designation” for its 
Huntington’s disease treatment. Id. ¶ 21. That designation recognizes that MMJ’s product 
targets rare diseases or conditions. See Pharm. Rsch. & Mfrs. of Am. v. HHS, 138 F. Supp. 3d 
31, 34 (D.D.C. 2015). But that recognition is separate from and “does not alter the standard 

26 
regulatory requirements and process for obtaining marketing approval.” Id. (cleaned up). 
Indeed, “a large majority of drugs with orphan designations do not have approval to be marketed 
in the United States at all.” Id. (cleaned up). 
MMJ has continued its efforts since then, but in February 2025, FDA issued a full clinical 
hold on MMJ’s multiple sclerosis program. Boise Decl. ¶¶ 20, 25. That hold remains in place as 
of this lawsuit, and FDA-approval procedures may continue for years. Hr’g. Tr. at 39:25–40:03. 
Even Plaintiffs’ counsel acknowledged at oral argument that a seven- or eight-year timeline for 
FDA approval would fall within “the normal course.” Id. at 40:05. 
This means that MMJ has not shown that it will offer its therapeutics to Medicare 
beneficiaries—and thus compete with those who do—anytime soon. It does not know, among 
other things: (1) when or if the DEA will approve its bulk manufacturing registration; (2) when 
FDA might lift its hold; (3) how long its clinical trials will run; (4) whether those trials will be 
successful; and (5) when (if ever) FDA will approve its products. See generally Boise Decl. 
That many steps away from entering the Medicare beneficiary market, MMJ’s alleged 
competitive injury “is too remote to confer standing.” See New World, 294 F.3d at 172. More, 
many of these links “depend[] on the independent actions” of FDA and DEA (neither of which 
plays any role in the BEI or is party to this lawsuit), calling for further speculation about MMJ’s 
market entry prospects. See id. Because MMJ has not said—because it cannot say —when it 
may start competing in the Medicare beneficiary market, neither can this Court. MMJ lacks a 
competitive injury to mount its case.
7 
 
7 Having concluded that MMJ is not a direct or current competitor, the Court need not address 
other questions competitor standing raises, such as whether there is sufficient market overlap 
between MMJ’s marijuana product and the over-counter-hemp the BEI targets, see Hemp 
Industries Ass’n v. DEA, 36 F.4th 269, 270–71 (D.C. Cir. 2022), or whether the competition 
“adversely affect[s]” MMJ’s “bottom line,” See New World, 294 F.3d at 170.
 

27 
Sherley v. Sebelius, 610 F.3d 69 (D.C. Cir. 2010), is not to the contrary. True, plaintiffs 
in that case had competitor standing without an approved product on the market. Id. at 71–72. 
But the parallels between them and MMJ end there. The Sherley plaintiffs were grant applicants, 
who sought federal funding for their research. Id. at 71. They challenged a rule that allowed 
more applicants to compete for the same pool of money. Id. Federal funding, not a product the 
plaintiffs or their competitors planned to sell, was thus the object of competition. MMJ is 
different. It does not gripe that the BEI vests others with funding or other federal benefits at its 
expense. It complains that the BEI could stiffen competition of cannabis-derived-product sales 
to Medicare beneficiaries even though MMJ has no sense of when it might make those sales. 
Sherley does not apply. 
To the extent MMJ argues that weakening investment prospects alternatively establish an 
injury, that theory fails too. See Boise Decl. ¶ 37 (claiming the BEI “risks weakening incentives 
for investment” into its drug development program). MMJ makes no allegation that an investor 
pulled out, that revenue declined, or that partners walked. Its vague references to “investor 
confidence” without more, Id. ¶ 40, are too speculative to save MMJ’s claims. Lujan, 504 U.S. 
555 at 561. Even MMJ distanced itself from this standing theory at oral argument, explaining 
that investor uncertainty “goes to the merits more than standing.” Hr’g Tr. 10:03–10:04. These 
allegations thus do not make up for what other allegations lacked. MMJ has not alleged 
standing. 
IV. 
All this leaves one more standing theory to go. Separate from individual, organizational, 
associational, and competitor standing, all Plaintiffs try another angle. They argue that 
procedural standing caselaw relieves them from the burden they would normally bear. Recall 

28 
that among Plaintiffs’ bevy of claims, they fault CMS for denying them the right to participate in 
notice-and-comment rulemaking. Am. Compl. ¶ 52, 150–59. This claim triggers procedural 
standing’s requirements. See Nat’l Council for Adoption v. Blinken, 4 F.4th 106, 113 (D.C. Cir. 
2021). 
When “plaintiffs allege injury resulting from violation of a procedural right afforded to 
them by statute and designed to protect their threatened concrete interest, the courts relax—while 
not wholly eliminating—the issues of imminence and redressability, but not the issues of injury 
in fact . . . .” Ctr. for L. & Educ. v. Dep’t of Educ., 396 F.3d 1152, 1157 (D.C. Cir. 2005); see 
Fla. Audubon Soc’y v. Bentsen, 94 F.3d 658, 664–65 (D.C. Cir. 1996) (en banc). The relaxed 
standard still leaves Plaintiffs with two showings to make: (1) the Secretary violated a procedural 
right designed to protect their concrete interest; and (2) that violation resulted in “injury” to their 
“concrete, particularized interest.” Ctr. for L. & Educ., 396 F.3d at 1157. Plaintiffs fail on both 
fronts. 
First, no Plaintiff has shown an injury to its concrete interests. To do so, Plaintiffs 
needed to show they “suffered personal and particularized injury” from the allegedly 
procedurally deficient BEI. Int’l Bhd. of Teamsters v. Transp. Sec. Admin., 429 F.3d 1130, 1135 
(D.C. Cir. 2005) (cleaned up). This Article III injury and the alleged procedural violation “are 
not one and the same.” Ctr. for L. & Educ., 396 F.3d at 1159. Indeed, the “mere inability to 
comment . 
. . in and of itself, does not establish an actual injury.” See Int’l Bhd. of Teamsters, 
429 F.3d at 1135 (cleaned up). Procedural standing instead demands a “concrete harm” like 
other standing theories. Spokeo, 578 U.S. at 341; see also Summers v. Earth Island Inst., 555 
U.S. 488, 497 (“Unlike redressability, however, the requirement of injury in fact is a hard floor 
of Article III jurisdiction that cannot be removed by statute.”). Recall that Plaintiffs have not 

29 
met that bar. See supra Part III.A (explaining why individual Plaintiffs failed to show injury-in-
fact); Part III.B (explaining why no organizational Plaintiffs established injury-in-fact); Part III.C 
(explaining why MMJ did not allege a competitive injury-in-fact). Repacking the same alleged 
harms under a new label will not change the outcome. 
Even if Plaintiffs had an Article III injury, though, they collide with the next requirement. 
They have not identified a statute that affords the “procedural right” at hand. Ctr. for L. & 
Educ., 396 F.3d at 1157. Plaintiffs point to the APA’s requirement for agencies to conduct 
notice-and-comment rulemaking as the hook. 5 U.S.C. § 553; Pls.’ Memo. at 25, ECF No. 28. 
The trouble for Plaintiffs is that a subsection of that very provision exempts from rulemaking 
procedures any matter “relating to . . . benefits.” 5 U.S.C. § 553(a)(2). Even “construed 
narrowly,” the D.C. Circuit has explained, this section “cuts a wide swath through the safeguards 
generally imposed on agency action,” and it “prevails when grants, benefits or other named 
subjects are clearly and directly implicated.” See Humana of S.C., Inc. v. Califano, 590 F.2d 
1070, 1082 (D.C. Cir. 1978) (cleaned up). The BEI, as a voluntary component to a Medicare 
payment model, “implicate[s]” Medicare benefits. Id.; see also Azar v. Allina Health Servs., 587 
U.S. 566, 569 (2019) (“While the APA requires many other agencies to offer public notice and a 
comment period before adopting new regulations, it does not apply to public benefit programs 
like Medicare.”). Because the APA exempts the BEI from notice-and-comment rulemaking, it 
cannot provide grounds to challenge the failure to engage in that process.
8 
 
8 The Court does not decide whether, the benefits-exemptions aside, CMS may implement the 
BEI without notice-and-comment under the theory that the BEI is not a legislative rule. This is a 
merits question that could prove a separate obstacle to the application of 5 U.S.C. § 553. See 
Pac. Gas & Elec. Co. v. Fed. Power Comm’n, 506 F.2d 33, 37 (D.C. Cir. 1974). For the same 
reason, the Court does not address whether Plaintiffs fall within a statute’s zone of interests and 
thus have a cause of action. See Herero People’s Reparations Corp. v. Deutsche Bank, A.G., 
370 F.3d 1192, 1194 (D.C. Cir. 2004) (“[T]he question whether a cause of action exists calls for 

30 
Plaintiffs respond first that Humana involved a different kind of agency action, a standard 
reimbursement regulation. Pls.’ Opp’n at 12, ECF No. 34. But they never explain why a 
Medicare payment model component is less “related to” to Medicare benefits than a Medicare 
reimbursement programs. 5 U.S.C. § 553(a)(2). Plaintiffs separately assert that HHS’s half-
century practice of voluntarily conducting notice-and-comment rulemaking for benefits and 
contracts matters reflects the “importance of public participation in Medicare rulemaking.” Pls.’ 
Opp’n at 12. But HHS has rescinded that policy. See Policy on Adhering to the Text of the 
Administrative Procedure Act, 90 Fed. Reg. 11,029 (Mar. 3, 2025). Its past choice to do more 
than a statute demands does not increase what that statute actually demands. With no right to 
notice-and-comment rulemaking, Plaintiffs lack procedural standing. 
V. 
 In sum, no matter the theory, Plaintiffs have failed to establish an Article III injury from 
the BEI’s implementation. The use and regulation of hemp are important matters, and Plaintiffs 
understandably have strong views on these topics. But while they may not like the BEI, they 
have not been injured by it. The case will thus be dismissed for lack of subject matter 
jurisdiction. A separate Order will issue today. 
 
 
Dated: May 22, 2026 TREVOR N. McFADDEN, U.S.D.J. 
 
a judgment on the merits, not jurisdiction.”); CSL Plasma Inc. v. U.S. Customs & Border Prot., 
33 F.4th 584, 588 (D.C. Cir. 2022) (“Our cases have repeatedly recognized the non-jurisdictional 
nature of the zone of interests test since Lexmark was decided in 2014.”). 
 
 
 

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