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No. 9522064
United States Court of Appeals for the Ninth Circuit
Caremark, LLC v. Choctaw Nation
No. 9522064 · Decided June 10, 2024
No. 9522064·Ninth Circuit · 2024·
FlawFinder last updated this page Apr. 2, 2026
Case Details
Court
United States Court of Appeals for the Ninth Circuit
Decided
June 10, 2024
Citation
No. 9522064
Disposition
See opinion text.
Full Opinion
FOR PUBLICATION
UNITED STATES COURT OF APPEALS
FOR THE NINTH CIRCUIT
CAREMARK, LLC; CAREMARK No. 22-15543
PHC, LLC; CAREMARKPCS
HEALTH LLC; CAREMARK RX D.C. No.
LLC; AETNA, INC.; AETNA 2:21-cv-01554-
HEALTH, INC., SMB
Plaintiffs-Appellees,
v.
OPINION
CHOCTAW NATION; CHOCTAW
NATION HEALTH SERVICES
AUTHORITY; CHOCTAW HEALTH
CARE, TALIHINA, OK; CHOCTAW
NATION HEALTH CLINIC-RUBIN
WHITE, POTEAU; CHOCTAW
NATION HEALTH CLINIC-
MCALESTER; CHOCTAW NATION
HEALTH CLINIC-IDABEL;
CHOCTAW NATION HEALTH
CLINIC-STIGLER; CHOCTAW
NATION HEALTH CLINIC-HUGO;
CHOCTAW NATION HEALTH
CLINIC-ATOKA; CHOCTAW
NATION HEALTH CARE CENTER
DURANT PHARMACY; CHOCTAW
NATION ONLINE PHARMACY
REFILL CENTER,
Defendants-Appellants.
2 CAREMARK V. CHOCTAW NATION
Appeal from the United States District Court
for the District of Arizona
Susan M. Brnovich, District Judge, Presiding
Argued and Submitted October 18, 2023
Phoenix, Arizona
Filed June 10, 2024
Before: Sandra S. Ikuta, Bridget S. Bade, and Daniel A.
Bress, Circuit Judges.
Opinion by Judge Bade
SUMMARY*
Arbitration
The panel affirmed the district court’s order granting the
petition of Caremark, LLC, and its affiliates to compel
arbitration of claims brought under the Recovery Act, 25
U.S.C. § 1621e, a provision of the Indian Health Care
Improvement Act, by the Choctaw Nation and several
pharmacies that it owns and operates.
The Nation and Caremark entered agreements to
facilitate insurance reimbursements for the Nation’s costs
for pharmacy services for its members. The Nation filed suit
in the Eastern District of Oklahoma, alleging that Caremark,
*
This summary constitutes no part of the opinion of the court. It has
been prepared by court staff for the convenience of the reader.
CAREMARK V. CHOCTAW NATION 3
as the insurers’ pharmacy benefit manager, unlawfully
denied pharmacy reimbursement claims in violation of the
Recovery Act. After the matter was stayed in the Eastern
District of Oklahoma, Caremark petitioned under the Federal
Arbitration Act to compel arbitration of the Nation’s claims
in the District of Arizona. The district court granted the
petition, concluding that the parties’ agreements included
arbitration provisions with delegation clauses and therefore
an arbitrator must decide the Nation’s arguments that its
claims are not arbitrable.
The panel held that most of the Nation’s arguments
challenging the district court’s arbitration order were
foreclosed by Caremark, LLC v. Chickasaw Nation, 43 F.4th
1021 (9th Cir. 2022), which addressed the enforceability of
identical arbitration provisions. In Chickasaw, the court held
that the Chickasaw Nation formed contracts with Caremark,
and those contracts included arbitration provisions with
delegation clauses. Therefore, the question whether there
had been a waiver of tribal sovereign immunity was an
enforceability question delegated to the arbitrator. The court
also rejected the Chickasaw Nation’s argument that its
claims were not arbitrable because the Recovery Act itself
precludes the enforcement of any agreement to arbitrate. The
court held that a challenge to arbitration on the ground that a
statute precludes arbitration is a threshold arbitrability issue
delegated to the arbitrator in the first instance.
The panel held that the Nation’s remaining argument that
the District of Arizona lacked subject-matter jurisdiction
over the petition to compel arbitration failed because the
Nation contractually agreed to arbitrate its claims against
Caremark in Arizona, and in those contracts specifically
“agree[d] to such jurisdiction.” Thus, the Nation expressly
4 CAREMARK V. CHOCTAW NATION
waived its tribal sovereign immunity as a bar to arbitration
in the District of Arizona.
COUNSEL
Sarah M. Harris (argued), Kimberly Broecker, and Libby
Baird, Williams and Connolly LLP, Washington, D.C.; Jon
T. Neuman, Greenberg Traurig LLP, Phoenix, Arizona;
Peter J. Kocoras, Thompson Hine LLP, Chicago, Illinois; for
Plaintiffs-Appellees.
Jessica Underwood (argued), Michael B. Angelovich, Chad
E. Ihrig, Bradley W. Beskin, and Nicholas W. Shodrok, Nix
Patterson LLP, Austin, Texas; Michael Burrage, Patricia A.
Sawyer, and Reggie N. Whitten, Whitten Burrage,
Oklahoma City, Oklahoma; for Defendants-Appellants.
OPINION
BADE, Circuit Judge:
The Choctaw Nation and several pharmacies that it owns
and operates (collectively, the Nation or the Choctaw
Nation) appeal from a district court order compelling
arbitration of the Nation’s dispute with Caremark, LLC, and
its affiliates (collectively, Caremark). Over several years,
the Nation and Caremark entered agreements to facilitate
insurance reimbursements for the Nation’s costs for
pharmacy services for its members. This dispute began
when the Nation filed suit in the Eastern District of
Oklahoma alleging that Caremark, as the insurers’ pharmacy
benefit manager, unlawfully denied pharmacy
CAREMARK V. CHOCTAW NATION 5
reimbursement claims in violation of the Recovery Act,
25 U.S.C. § 1621e, a provision of the Indian Health Care
Improvement Act. After the matter was stayed in the Eastern
District of Oklahoma, Caremark petitioned to compel
arbitration of the Nation’s claims in the District of Arizona.
The district court granted the petition, concluding that the
parties’ agreements included arbitration provisions with
delegation clauses and therefore an arbitrator must decide
the Nation’s arguments that its claims are not arbitrable.
In this appeal, most of the Choctaw Nation’s arguments
challenging the district court’s arbitration order are
foreclosed by our decision in Caremark, LLC v. Chickasaw
Nation, 43 F.4th 1021 (9th Cir. 2022). The Nation’s main
remaining argument that the District of Arizona lacked
subject-matter jurisdiction over the petition to compel
arbitration fails because the Nation contractually agreed to
arbitrate its claims against Caremark in Arizona, and in those
contracts specifically “agree[d] to such jurisdiction.” Thus,
the Nation expressly waived its tribal sovereign immunity as
a bar to arbitration in the District of Arizona, and the district
court had subject-matter jurisdiction to decide the motion to
compel arbitration. We affirm.
I.
A.
The Choctaw Nation is a sovereign and federally
recognized Native American tribal nation headquartered in
Oklahoma. The Choctaw Nation owns and operates
healthcare facilities, including pharmacies, that serve
Choctaw citizens and other Native persons throughout the
Choctaw region. Caremark provides pharmacy benefit
management services to insurers, third-party administrators,
and employer sponsors of group health plans. These services
6 CAREMARK V. CHOCTAW NATION
include the administration and maintenance of pharmacy
provider networks. The Choctaw Nation’s pharmacies are
participants in various pharmacy networks administered by
Caremark.
As participants in Caremark’s pharmacy networks, the
Choctaw Nation’s pharmacies signed Provider Agreements
with Caremark (or its predecessor) in 2003, 2005, 2008, and
2010. Each Provider Agreement incorporates by reference a
Provider Manual, which governs each pharmacy’s
relationship with Caremark.1 The Provider Manuals, which
Caremark issued and sent to the pharmacies in 2004, 2007,
2009, 2011, 2014, 2016, 2018, and 2020, each contain an
arbitration provision. The arbitration provision provides,
Any and all disputes between Provider and
Caremark . . . including but not limited to,
disputes in connection with, arising out of, or
relating in any way to, the Provider
Agreement or to Provider’s participation in
one or more Caremark networks or exclusion
from any Caremark networks, will be
exclusively settled by arbitration.
The arbitration provision further provides that “the
arbitration shall be administered by the American
Arbitration Association (AAA) pursuant to the then
applicable AAA Commercial Arbitration Rules and
Mediation Procedures.” And it provides that “[t]his
1
The Choctaw Nation and its pharmacies are “Providers” under the
Provider Agreements and Provider Manuals. The Provider Agreements
and incorporated Provider Manuals here are identical to those at issue in
Chickasaw.
CAREMARK V. CHOCTAW NATION 7
arbitration agreement . . . shall be governed by the Federal
Arbitration Act, 9 U.S.C. §§ 1–16.”
The arbitration provision also includes a delegation
clause, in which the parties agreed,
The arbitrator(s) shall have exclusive
authority to resolve any dispute relating to the
interpretation, applicability, enforceability or
formation of the agreement to arbitrate,
including but not limited to, any claim that all
or part of the agreement to arbitrate is void or
voidable for any reason.
The arbitration provision provides that the arbitrator’s award
“will be final and binding on the parties, and judgment upon
such award may be entered in any court having jurisdiction
thereof.” Finally, the arbitration provision provides that any
arbitration “must be conducted in Scottsdale, Arizona and
Provider agrees to such jurisdiction, unless otherwise agreed
to by the parties in writing.”
B.
Under federal law, a member of a tribal nation, including
the Choctaw Nation, may obtain prescription medication
that is fully funded by that nation. See Chickasaw, 43 F.4th
at 1025. The tribal nation receives federal funding for these
medication costs through Indian Health Services, an agency
within the Department of Health and Human Services that
provides medical services and funding to federally
recognized Native American tribal nations. See 25 U.S.C.
§ 1621 et seq. In addition to federally funded healthcare,
many tribal members have private insurance coverage, often
through the member’s employee benefits. Chickasaw,
8 CAREMARK V. CHOCTAW NATION
43 F.4th at 1027. When tribal members have such dual
coverage, private insurers have primary payment
responsibility, and the Recovery Act provides that the tribal
nation is the “payer of last resort.” 25 U.S.C. § 1623(b).
In these circumstances, when the Nation’s pharmacies
fill prescriptions for the tribal members, the pharmacies may
seek recovery of these costs from private insurers under the
Recovery Act. See Chickasaw, 43 F.4th at 1027 (explaining
that the Recovery Act enables “tribal governments to enforce
the statutory ‘right of recovery’ by bringing a civil action to
recoup from any applicable insurer the cost of services
provided to tribal members” (citing 25 U.S.C. § 1621e(a),
(e)(1)(B))). The Recovery Act further provides that “no
provision of any contract, insurance or health maintenance
organization policy, employee benefit plan, self-insurance
plan, managed care plan, or other health care plan or
program . . . shall prevent or hinder the right of recovery of
the United States, an Indian tribe, or tribal organization.”
25 U.S.C. § 1621e(c).
In April 2021, the Choctaw Nation sued Caremark in the
Eastern District of Oklahoma for reimbursement of
healthcare costs under the Recovery Act. See Choctaw
Nation v. Caremark PHC, LLC, No. 6:21-cv-00128 (E.D.
Okla. Apr. 26, 2021), ECF 1. In its complaint, the Choctaw
Nation alleged that Caremark violated the Recovery Act by
improperly denying claims for covered medications that the
Nation had submitted on behalf of tribal members.
Caremark, in response, moved to stay the proceedings in the
Eastern District of Oklahoma based on the arbitration
provisions in the Provider Manuals, which require disputes
to “be exclusively settled by arbitration . . . in Scottsdale,
Arizona.” The district court granted the motion and stayed
the proceedings.
CAREMARK V. CHOCTAW NATION 9
Caremark then filed a petition to compel arbitration
under the Federal Arbitration Act (FAA) in the District of
Arizona. Caremark argued that the terms of the Provider
Manuals required the Choctaw Nation to arbitrate its
reimbursement claims. The Choctaw Nation opposed the
petition. The Nation argued that it had not signed
agreements that clearly and unequivocally waived its
sovereign immunity to allow arbitration of its Recovery Act
claims against Caremark, and that it did not waive its
immunity to arbitration proceedings in the District of
Arizona by filing suit in the Eastern District of Oklahoma.
The Nation also argued that the Recovery Act displaces the
arbitration provisions in the Provider Manuals, rendering
those agreements to arbitrate unenforceable.
The district court granted the petition and compelled the
parties to arbitrate under § 4 of the FAA. The district court
first found that, under the Provider Agreements, the Choctaw
Nation had agreed to the terms of the incorporated Provider
Manuals, including the arbitration provisions. The district
court also found that the arbitration provisions included
“clear and unmistakable” delegation clauses, which required
an arbitrator—not the district court—to “decide the
threshold question of arbitrability.” Given those findings,
the district court concluded that “the Nation has waived its
sovereign immunity for claims brought related to the
Provider Agreement[s].” And finally, the district court
determined that whether the Recovery Act displaces the
arbitration provisions is a threshold arbitrability question for
the arbitrator to decide. The Choctaw Nation timely
appealed.
10 CAREMARK V. CHOCTAW NATION
C.
In this appeal, the Choctaw Nation first argues that its
claims are not arbitrable by asserting the same arguments
that we rejected in Chickasaw.2 Specifically, the Choctaw
Nation, like the Chickasaw Nation before it, acknowledges
that it entered Provider Agreements with Caremark, but
argues that (1) the Provider Agreements, as opposed to the
Provider Manuals they incorporate by reference, do not
contain arbitration provisions with delegation clauses,
(2) the Nation could not have clearly and unequivocally
waived its sovereign immunity for arbitration proceedings
by entering these agreements because the tribal
representatives who signed the contracts on its behalf were
not authorized to waive immunity, and (3) even if the Nation
entered valid arbitration agreements, the Recovery Act
precludes the enforcement of any agreement to arbitrate.
Because Chickasaw is binding precedent that rejected
these arguments challenging the enforceability of identical
arbitration provisions, see 43 F.4th at 1030–34, we must
follow it and likewise reject these arguments. See Miller v.
Gammie, 335 F.3d 889, 899–900 (9th Cir. 2003) (en banc)
(explaining that “a three-judge panel may not overrule a
prior decision of the court,” unless that decision has been
2
In the district court, the Choctaw Nation filed a motion to stay the
proceedings pending our decision in Chickasaw, acknowledging that
Chickasaw would “necessarily control—the resolution of the exact same
issues present here.” Respondents’ Motion to Stay, Caremark, LLC v.
Choctaw Nation, No. 2:21-cv-01554, ECF No. 16, at 2–3 (D. Ariz. Oct.
7, 2021). The Nation reasserted these arguments in a motion to hold this
appeal in abeyance, and described Chickasaw and this case as “virtually
identical,” and “substantially similar (if not identical).” Motion to Hold
Appeal in Abeyance, Caremark, LLC v. Choctaw Nation, No. 22-15543,
Dkt. No. 16, at 2, 5 (9th Cir. May 26, 2022).
CAREMARK V. CHOCTAW NATION 11
“effectively overruled” by a higher authority). Therefore,
we do not repeat our analysis in Chickasaw, but instead at
this point merely summarize its holdings. We will discuss
Chickasaw again later in this opinion in further explaining
why it forecloses many of the Choctaw Nation’s arguments
on appeal.
In Chickasaw, we concluded that the Chickasaw Nation
“formed contracts with Caremark,” “[a]nd the language of
those contracts includes arbitration provisions with
delegation clauses.” Chickasaw, 43 F.4th at 1031. We then
applied the well-settled law that arbitrators, not courts, must
resolve challenges to “the scope or enforceability of [an]
arbitration provision” when the parties have “form[ed] an
agreement to arbitrate containing an enforceable delegation
clause.” Id. at 1030.
We accordingly rejected the Chickasaw Nation’s
argument that its claims were not arbitrable “because it never
clearly and unequivocally waived its tribal sovereign
immunity,” id. at 1028, and held that “whether there has
been a waiver of tribal immunity for particular claims for
which arbitration is sought” is an enforceability question
delegated to the arbitrator, id. at 1032–33. We
acknowledged that “[a]n arbitration agreement may or may
not have implications for a tribe’s sovereign immunity,” but
held that “courts need not resolve the sovereign-immunity
implications (if any) before deciding whether an agreement
to arbitrate exists at all.”3 Id. at 1032.
3
We explained that “a forum-selection clause—which, like an
arbitration provision, is an agreement to bring any disputes to a particular
forum—does not necessarily waive sovereign immunity” as to any
12 CAREMARK V. CHOCTAW NATION
We also rejected the Chickasaw Nation’s argument that
its claims were not arbitrable because “the Recovery Act
itself precludes the enforcement of any agreement to
arbitrate.” Id. at 1028. We held that challenges to arbitration
on the ground that a statute precludes arbitration is a
“threshold arbitrability issue that the parties have delegated
to the arbitrator” to “decide in the first instance.” Id. at 1034.
We likened the argument that the Recovery Act displaces
any arbitration provision to an unconscionability challenge.
Id. at 1033 (citing Rent-A-Ctr., W., Inc. v. Jackson, 561 U.S.
63, 72 (2010)). That is, the argument that the Recovery Act
displaces a contract’s arbitration provision “does not impugn
the validity of the delegation clauses specifically”; it instead
“is a challenge to the enforceability of the arbitration
provision[] as a whole,” which is a threshold arbitrability
issue “delegated to the arbitrator.”4 Id. at 1033–34. We
expressed no opinion on the enforceability of the arbitration
particular claim. Chickasaw, 43 F.4th at 1032 (citing Ute Indian Tribe
of the Uintah & Ouray Rsrv. v. Utah, 790 F.3d 1000, 1010 (10th Cir.
2015)). Therefore, we concluded that entering an arbitration agreement
also does not necessarily waive sovereign immunity as to particular
claims, but we declined to “put the cart before the horse” and decide
whether immunity is waived for particular claims before deciding
whether an arbitration agreement exists. Id. at 1032–33. Instead, we
concluded that whether an arbitration provision with a delegation clause
is enforceable as to particular claims is an issue that the arbitrator must
decide in the first instance. Id. at 1034.
4
The Choctaw Nation attempts to distinguish Chickasaw by asserting
that it “expressly challenges” the enforceability and validity of the
delegation clauses in its contracts with Caremark because it argues that
the Recovery Act renders these clauses unenforceable. But this is simply
a restatement of the argument that we rejected in Chickasaw, concluding
that it raised a threshold arbitrability issue that the parties had delegated
to the arbitrator because it did not “specifically” attack the validity of the
delegation clauses. See id. at 1033–34.
CAREMARK V. CHOCTAW NATION 13
provisions as to certain claims or whether the Recovery Act
precluded arbitration of the Chickasaw Nation’s claims.5 Id.
Importantly for this appeal, however, in Chickasaw we
expressly declined to decide whether “the Nation’s
sovereign immunity bar[red] Caremark from initiating a
proceeding against the Nation in the Arizona district court to
compel arbitration.” Id. at 1033 n.11. We explained that the
issue had not been “specifically and distinctly” argued in the
opening brief or “adequately developed in the reply brief.”
Id. (quoting Christian Legal Soc’y Chapter of Univ. of Cal.
v. Wu, 626 F.3d 483, 485 (9th Cir. 2010)); see also Acres
Bonusing, Inc. v. Marston, 17 F.4th 901, 907 (9th Cir. 2021)
(explaining that “[t]ribal sovereign immunity is ‘quasi-
jurisdictional,’ in the sense that we do not raise the issue on
our own,” and therefore it may be considered an affirmative
defense that is forfeited if not asserted (quoting Pistor v.
Garcia, 791 F.3d 1104, 1110–11 (9th Cir. 2015))).
Although it did not raise this issue in the district court,
the Choctaw Nation now asks us to decide the issue that we
did not reach in Chickasaw: whether the Choctaw Nation
waived its sovereign immunity to suit in the District of
Arizona to compel arbitration. We conclude that by entering
contracts with arbitration provisions, and agreeing that any
5
In this appeal, the Choctaw Nation also asserts that the Recovery Act
precludes arbitration under the “effective vindication” exception to
arbitrability, “which permits the invalidation of an arbitration agreement
when arbitration would prevent the ‘effective vindication’ of a federal
statute.” Ferguson v. Corinthian Colls., Inc., 733 F.3d 928, 936 (9th Cir.
2013). Although we did not squarely address the effective vindication
exception in Chickasaw, it is likewise “a challenge to the enforceability
of the arbitration provisions as a whole” and therefore must be left “for
the arbitrator.” 43 F.4th at 1033. Thus, Chickasaw forecloses this
argument too.
14 CAREMARK V. CHOCTAW NATION
arbitration of its claims against Caremark would take place
in Arizona and “agree[ing] to such jurisdiction,” the
Choctaw Nation expressly waived its sovereign immunity to
suit in Arizona to compel arbitration. Accordingly, the
District of Arizona had subject-matter jurisdiction to decide
the petition to compel arbitration. See Acres Bonusing,
17 F.4th at 908 (collecting cases and explaining that when
tribal sovereign immunity applies, the district court lacks
subject-matter jurisdiction).
II.
We have jurisdiction under 9 U.S.C. § 16(a)(3) and
28 U.S.C. § 1291. “We review de novo a district court’s
decision to grant or deny a petition to compel arbitration.”
Chickasaw, 43 F.4th at 1028. Likewise, whether a tribal
nation has waived its sovereign immunity is reviewed de
novo. Bodi v. Shingle Springs Band of Miwok Indians,
832 F.3d 1011, 1015 (9th Cir. 2016).
III.
“The doctrine of tribal sovereign immunity derives from
the status of Indian tribes as ‘separate sovereigns preexisting
the Constitution.’” Id. at 1016 (quoting Michigan v. Bay
Mills Indian Cmty., 572 U.S. 782, 788 (2014)). Tribes
possess “the common-law immunity from suit traditionally
enjoyed by sovereign powers.” Bay Mills, 572 U.S. at 788
(internal quotation marks and citation omitted). And that
immunity “is a necessary corollary to Indian sovereignty and
self-governance.” Id. (internal quotation marks and citation
omitted).
“[A] tribe may lose its immunity from suit” in “only two
ways”: its tribal immunity may be abrogated by Congress,
“[o]r, of relevance to this appeal, a tribe may itself waive
CAREMARK V. CHOCTAW NATION 15
immunity.” Bodi, 832 F.3d at 1016 (citations omitted). “It
is well settled that a waiver of [tribal] sovereign immunity
cannot be implied but must be unequivocally expressed.” Id.
(alteration in original) (internal quotation marks omitted)
(quoting Santa Clara Pueblo v. Martinez, 436 U.S. 49, 58
(1978)). Thus, “suits against Indian tribes are . . . barred” by
sovereign immunity “absent a clear and unequivocally
expressed waiver by a tribe or congressional abrogation.”
Id. at 1016–17 (alteration, internal quotation marks, and
citations omitted).
The question presented here is whether the Choctaw
Nation clearly and unequivocally waived its tribal sovereign
immunity such that the District of Arizona had jurisdiction
over Caremark’s petition to compel arbitration. See id.
Caremark asserts that the Nation waived its immunity to a
suit in Arizona seeking to compel arbitration by entering
contracts agreeing to arbitrate the parties’ disputes in
Arizona.6 Specifically, Caremark argues that the Nation
6
In addition to its arguments that the Nation contractually waived its
sovereign immunity, Caremark also argues that the Nation waived its
sovereign immunity from a suit to compel arbitration proceedings in the
District of Arizona by filing a lawsuit against Caremark in the Eastern
District of Oklahoma. The parties do not dispute that the “[i]nitiation of
a lawsuit necessarily establishes consent to the court’s adjudication of
the merits of that particular controversy.” McClendon v. United States,
885 F.2d 627, 630 (9th Cir. 1989). Thus, the Choctaw Nation
acknowledges that it explicitly waived its sovereign immunity for its
claims against Caremark by filing suit in the Eastern District of
Oklahoma. And it concedes that the arbitration of these claims is
inextricably intertwined with the resolution of those claims. But it
argues that filing suit in the Eastern District of Oklahoma did not also
waive its sovereign immunity as to Caremark’s motion to compel
arbitration proceedings in the District of Arizona. Because we conclude
16 CAREMARK V. CHOCTAW NATION
contractually agreed to arbitrate any disputes arising under
the Provider Agreements in Arizona, and explicitly
“agree[d] to such jurisdiction.” Accordingly, by executing
the Provider Agreements, the Choctaw Nation waived its
immunity in suits to compel arbitration proceedings in
Arizona.
The Nation does not dispute that tribal nations may
waive their sovereign immunity by contract. But it argues
that the agreements its representatives signed here were
insufficient do so—either because the agreements did not
contain arbitration provisions or because, even if the
agreements included such provisions, the Nation’s tribal
council did not authorize a waiver of its immunity.
Therefore, we must determine whether the Nation clearly
and unequivocally waived its sovereign immunity for
arbitration proceedings in Arizona through these contractual
provisions.
A.
To determine whether the Choctaw Nation waived its
sovereign immunity for arbitration proceedings in the
District of Arizona through its contracts with Caremark, we
must first determine whether those contracts were validly
formed. See Chickasaw, 43 F.4th at 1030. The Nation
acknowledges that it signed several Provider Agreements
with Caremark to facilitate reimbursement of pharmacy
costs. However, it argues that the Provider Agreements do
not contain an arbitration provision; instead, that provision
is in the Provider Manuals, which the Nation did not sign.
that the Nation contractually waived its sovereign immunity for
arbitration proceedings in the District of Arizona, we need not decide
this issue.
CAREMARK V. CHOCTAW NATION 17
Therefore, the Nation argues, it did not enter any arbitration
agreements with Caremark. 7 We rejected the identical
argument in Chickasaw, and we reject it again here because
the Provider Agreements expressly incorporate the Provider
Manuals. Id. at 1031. Here, as in Chickasaw, the Nation
“does not seriously dispute that its pharmacies have
contractual relationships with Caremark that are governed
by the terms of the Provider Manual[s].” Id. at 1030–31.
Indeed, the Choctaw Nation, like the Chickasaw Nation,
“does not disavow the contracts entirely.” Id. at 1031. At
oral argument, the Choctaw Nation suggested the contracts
were partially valid, at least to the extent that the Nation
received $90,500,000 in reimbursements for pharmacy
claims from 2014 to 2021. Thus, the Nation appears to
recognize that it formed valid contracts with Caremark, even
though it argues that the arbitration provisions in those
contracts are unenforceable. We therefore conclude that the
contracts between the Choctaw Nation and Caremark, which
are identical to the contracts at issue in Chickasaw, were
validly formed.
7
The Choctaw Nation, repeating the Chickasaw Nation’s arguments,
also suggests that Caremark “surreptitiously slipped [the arbitration
provisions] into the Provider Manuals.” But it offers no support for this
allegation, which is refuted by the undisputed record evidence that all
Provider Agreements signed by the Choctaw Nation pharmacies
expressly incorporate the Provider Manuals, that in 2007, 2009, 2011,
2014, 2016, 2018, and 2020, Caremark sent copies of the Provider
Manuals to the Nation’s pharmacies by Federal Express or UPS, and that
Caremark maintains proofs of delivery for the Provider Manuals
delivered by UPS from 2016 to 2020.
18 CAREMARK V. CHOCTAW NATION
B.
The Nation next argues that even if its representatives
had authority to contract with Caremark, they did not have
authority to waive sovereign immunity and subject the
Nation to arbitration proceedings in the District of Arizona.
Thus, the Nation tacitly acknowledges that its
representatives had authority to enter contracts with
Caremark but argues that it did not waive its sovereign
immunity in those contracts. Specifically, the Nation
contends that Choctaw law requires tribal council approval
of every decision to waive sovereign immunity, which the
signatories of the Provider Agreements lacked. We reject
this argument.
The Nation cites several cases to support its argument
that it did not waive its immunity through any “authorized”
arbitration provisions, and therefore, the district court did not
have jurisdiction over the petition to compel arbitration.
Most of these cases are inapposite because they address the
enforceability of arbitration provisions when a tribe’s
enacted laws, constitutions, ordinances, and codes require
specific procedures to waive immunity, and those provisions
were not followed. In these cases, the courts concluded that
the purported waivers of sovereign immunity—through
contracts that failed to comply with enacted tribal laws
governing such waivers—were not “clear and unequivocally
expressed” and therefore were ineffective.8 See Bodi,
8
See Sanderlin v. Seminole Tribe of Fla., 243 F.3d 1282, 1287–88
(11th Cir. 2001) (rejecting argument that tribal official implicitly waived
immunity for Rehabilitation Act suits by applying for federal funding
because tribal constitution and ordinance required resolution from tribal
council to waive immunity); World Touch Gaming, Inc. v. Massena
CAREMARK V. CHOCTAW NATION 19
832 F.3d at 1016–17 (citations omitted). But the Choctaw
Nation has not identified any specific tribal laws that apply
here; thus, it has not identified any conflict between its laws
and the terms of the Provider Agreements that would render
any contractual waiver of immunity unclear or equivocal.
The remaining cases that the Nation cites, which address
invalid contract formation, are not helpful because they turn
on specific facts that are not applicable or relevant here.9
Mgmt., LLC, 117 F. Supp. 2d 271, 272, 274–75 (N.D.N.Y. 2000)
(concluding that tribe did not waive its immunity under terms of sales
and lease agreements that management company signed because the
tribe’s constitution and civil judicial code required express, written
waiver by tribal council to waive immunity); Calvello v. Yankton Sioux
Tribe, 584 N.W.2d 108, 110, 112–13 (S.D. 1998) (concluding that tribal
constitution and bylaws required that tribal council authorize
agreements, and rejecting argument that tribe waived immunity through
attorney’s unauthorized participation in arbitration, or by entering
gaming compact with the state); Dilliner v. Seneca-Cayuga Tribe,
258 P.3d 516, 520 (Okla. 2011) (concluding that tribe’s constitution
required that tribe’s business committee pass resolutions to expressly
consent to a waiver of immunity, but resolutions at issue only authorized
the chief to enter employment contracts and did not authorize waiver of
immunity); Chance v. Coquille Indian Tribe, 963 P.2d 638, 641–42 (Or.
1998) (finding that purported waiver of immunity was unenforceable
because tribal corporation’s articles of incorporation required board
approval for president to enter contracts on corporation’s behalf, and the
board had not approved the contract at issue).
9
See Stillaguamish Tribe of Indians v. Pilchuck Grp. II, LLC, No. C10-
995RAJ, 2011 WL 4001088, at *5–7 (W.D. Wash. Sept. 7, 2011)
(explaining that contract clearly waived immunity, but concluding that
the tribe did not enter the contract); Attorney’s Process & Investigation
Servs., Inc. v. Sac & Fox Tribe, 401 F. Supp. 2d 952, 963 (N.D. Iowa
2005) (finding that agreement containing arbitration clause clearly
waived tribe’s sovereign immunity, but declining to reach that issue
because “the very validity of the Agreement [was] in dispute” as the
20 CAREMARK V. CHOCTAW NATION
Thus, these cases do not support the Nation’s argument that
it did not authorize its signatories to the Caremark contracts
to waive its tribal sovereign immunity for arbitration
proceedings in the District of Arizona.
In the absence of tribal law on point, the Nation relies on
a declaration from its Executive Director of Legal
Operations, Mr. Brian Danker, asserting that only the tribal
council may waive the Nation’s immunity, and that the
council did not authorize anyone to sign agreements with
Caremark that included a waiver of immunity.10 Mr. Danker
bases these statements on his purported knowledge of the
Nation’s “standing policy,” and his “experience.” But as an
initial matter, even if we accepted Mr. Danker’s opinions on
tribal court was required to resolve an intra-tribal conflict between
competing councils claiming authority to act on behalf of the tribe);
Hydrothermal Energy Corp. v. Fort Bidwell Indian Cmty. Council,
216 Cal. Rptr. 59, 61–63 (Ct. App. 1985) (concluding that contract the
tribal chairman purportedly entered was not valid because under the
tribe’s constitution and bylaws only the tribal council had authority to
enter contracts, and chairman stated by declaration that she signed
contracts at plaintiff’s request for “limited bookkeeping purposes” and
informed the plaintiff’s agent of the tribal procedure that required
council approval of any contract); MM&A Prods., LLC v. Yavapai-
Apache Nation, 316 P.3d 1248, 1250–54 (Ariz. Ct. App. 2014)
(explaining that tribe’s constitution and “Board Act” required the tribal
council to authorize contracts, which it had not done, and rejecting
argument that casino marketing director nonetheless had “apparent
authority” to enter the contracts and bind the tribe)
10
Mr. Danker’s declaration is identical to the declaration submitted to
make the same argument in Chickasaw, except for the name, title, and
employment history of the declarant. Compare Appellants’ Excerpt of
Record at 23–26, Caremark, LLC, et al. v. Choctaw Nation, et al., (No.
22-15553), ECF No. 26 (Jan. 9, 2023), with Appellants’ Excerpts of
Record at 18–21, Caremark, LLC v. Chickasaw Nation, 43 F.4th 1021
(9th Cir. 2022) (No. 21-16209), ECF No. 28 (Sept. 1, 2021).
CAREMARK V. CHOCTAW NATION 21
Choctaw law, his statements do not address the relevant
period. He avers that he has served as counsel for the
Choctaw Nation since December 2018, and he signed the
declaration in November 2021. Therefore, at the time he
signed the declaration, he had approximately three years’
experience as counsel for the Nation, all of which occurred
years after the parties entered the Provider Agreements
between 2003 and 2010, and after Caremark sent the
incorporated Provider Manuals to the Nation in 2007, 2009,
2011, 2014, 2016, and 2018. Mr. Danker provides no other
information to suggest he has additional experience or
knowledge to provide foundation for his opinions on the
Choctaw Nation’s laws and procedures prior to December
2018. Therefore, his statements, which seem to be offered
as lay opinions about Choctaw law, are not helpful or
authoritative.
Nonetheless, even if we consider the substance of Mr.
Danker’s opinions, they do not advance the Nation’s
arguments. Mr. Danker states that, “[a]s a matter of
Choctaw Nation law, only the Choctaw Nation Tribal
Council may waive the Choctaw Nation’s sovereign
immunity.”11 But he cites no Choctaw law to support this
statement. And as Caremark notes, the Choctaw
11
Some of Mr. Danker’s statements are more properly characterized as
advocacy. He asserts that “the Choctaw National Tribal Council [has
not] signed any agreement with any Petitioner named in the above-
referenced matter that contained any waiver of the Choctaw Nation’s
sovereign immunity.” That statement, however, simply repeats the
Nation’s arguments, which we rejected in Chickasaw and here, that its
representatives did not sign agreements that contained arbitration
provisions because they signed the Provider Agreements, and the
arbitration provisions are in the Provider Manuals. See supra Section
III.A.
22 CAREMARK V. CHOCTAW NATION
Constitution does not contain any such restriction. See
Constitution of the Choctaw Nation of Oklahoma,
https://www.choctawnation.com/about/history/historical-
documents/ (last visited June 3, 2024).
The Nation argues that it need not point to enacted tribal
law establishing procedures or restrictions for waiving
sovereign immunity because “a tribe . . . can proceed by
common law and constitutional principles, as well as by
statute.” But even if true, this is beside the point. Here, the
Nation has not identified any tribal law that governs waiver
of sovereign immunity.
Instead, the Nation argues that even if it entered valid
contracts with Caremark, and those contracts contain
arbitration provisions that waive sovereign immunity to
participating in the arbitration, it can nonetheless disavow
any such waiver with a declaration that is not supported by
any tribal law. But as set forth above, the cases that the
Nation cites to support this argument are inapposite; these
cases address the enforceability of arbitration provisions
when enacted tribal laws, constitutions, ordinances, and
codes require specific procedures to waive immunity and
those procedures are not followed. See cases cited supra
note 8. The Nation has not cited any authority to support the
proposition that, in the absence of any tribal law governing
or restricting waivers of immunity, a tribe can sign otherwise
enforceable contracts that include arbitration provisions,
reap the financial benefits of these contracts, and then
invalidate the arbitration provisions by having its legal
counsel declare them invalid based on unspecified tribal law
and policy.
In addition to lacking legal support, that proposition
would violate the caveat emptor principle underlying cases
CAREMARK V. CHOCTAW NATION 23
addressing tribal sovereign immunity: that parties entering
contracts with Native American tribal nations are, or should
be, aware of the principles of sovereign immunity and should
negotiate with the tribes accordingly to ensure that their
agreements are valid and binding. See, e.g., Bay Mills,
572 U.S. at 797 (“So as Michigan forthrightly
acknowledges, ‘a party dealing with a tribe in contract
negotiations has the power to protect itself by refusing to
deal absent the tribe’s waiver of sovereign immunity from
suit.’”); World Touch Gaming, 117 F. Supp. 2d at 275–76
(noting that “as a sophisticated distributor of gaming
equipment that frequently deals with Indian gaming
enterprises, World Touch should have been careful to assure
that . . . the Tribe . . . expressly waived sovereign
immunity” in the agreements); cf. Wells Fargo Bank, Nat’l
Ass’n v. Apache Tribe of Okla., 360 P.3d 1243, 1253 (Okla.
Ct. App. 2014) (explaining that “the harder it is for the tribe
to waive its sovereign immunity, the harder it is for it to
make advantageous business transactions” (quotation marks
and citation omitted)).
Accepting the Nation’s argument would mean that
parties dealing with a tribe would have no means of ensuring
that a contract provision that waives sovereign immunity
would be effective because, even if that party researched
tribal law and found no provisions governing immunity
waivers, the tribe could later simply invalidate the provision
with a declaration from its counsel that cites no tribal law.
In these circumstances, the party’s attempts to identify the
applicable tribal law would be futile because, according to
the Nation’s position, that law need not be enacted or
otherwise documented in the tribe’s common law.
Therefore, we conclude that the Nation did not establish
by its citation to inapposite cases, or by the declaration from
24 CAREMARK V. CHOCTAW NATION
its legal counsel, that any waiver of sovereign immunity in
the arbitration provisions in its agreements with Caremark is
unenforceable because the tribal representatives who signed
the contracts lacked authority to waive the Nation’s
sovereign immunity.
C.
Finally, we must determine whether, under the terms of
the valid contracts it entered with Caremark, the Choctaw
Nation clearly and unequivocally waived its sovereign
immunity for arbitration proceedings such that the District
of Arizona had jurisdiction over the petition to compel
arbitration.12 See Bodi, 832 F.3d at 1016; 9 U.S.C. § 4. The
Provider Agreements and the incorporated Provider
Manuals state that “[a]ny and all disputes between Provider
and Caremark . . . will be exclusively settled by arbitration,”
and specify that “[a]ny such arbitration must be conducted
in Scottsdale, Arizona and Provider agrees to such
jurisdiction, unless otherwise agreed to by the parties in
writing.” The arbitration provision also adopts the AAA
Commercial Arbitration Rules and Mediation Procedures,
which provide that “[p]arties to an arbitration under these
Rules shall be deemed to have consented that judgment upon
the arbitration award may be entered in any federal or state
12
By construing the contracts’ arbitration provisions to determine
whether the district court had jurisdiction over the petition to compel
arbitration, we do not “put the cart before the horse,” Chickasaw, 43
F.4th at 1032–33, because we have already determined that an arbitration
agreement exists, see supra Section III.A, and we are not determining
whether the Nation waived its sovereign immunity as to any particular
claim. Instead, we are addressing whether the Nation waived its
immunity from a motion to compel arbitration, which is a threshold issue
because when tribal sovereign immunity applies, the district court
“lack[s] subject matter jurisdiction.” Acres Bonusing, 17 F.4th at 908.
CAREMARK V. CHOCTAW NATION 25
court having jurisdiction thereof.” See Am. Arb. Ass’n,
Commercial Arbitration Rules and Mediation Procedures
R-54(c) (Sept. 1, 2022).13 And the arbitration provision
provides that “[t]his arbitration agreement . . . shall be
governed by the Federal Arbitration Act, 9 U.S.C. §§ 1–16.”
Thus, unlike in McClendon, where we concluded the tribe
had not waived its immunity, the “relevant documents in this
case” are not “silent with respect to the [Nation]’s consent to
suit” in Arizona. 885 F.2d at 632 (concluding that tribe had
not waived sovereign immunity where its contractual
documents presented no indication of “an intent to waive
sovereign immunity” and “contain[ed] no provision
governing sovereign immunity or consent to suit”).
Instead, the arbitration provision at issue here is
remarkably similar to the arbitration provision at issue in C
& L Enterprises, Inc. v. Citizen Band Potawatomi Indian
Tribe of Oklahoma, 532 U.S. 411 (2001). There, the Court
concluded that the Potawatomi Nation “clearly consented to
arbitration and to the enforcement of arbitral awards in
Oklahoma state court,” and “thereby waived its sovereign
immunity from C & L’s suit” to enforce an arbitration award.
Id. at 423. The “contract’s provision for arbitration and
related prescriptions [led the Court] to this conclusion.” Id.
at 418. The arbitration clause stated, like the one at issue
here, that “[a]ll claims or disputes between [the
parties] . . . shall be decided by arbitration.” Id. at 415.
And, like the arbitration provision here, it adopted the AAA
rules providing that “the arbitration award may be entered in
any federal or state court having jurisdiction thereof.” Id.
13
For current and archived versions of these rules, see Rules, Forms,
Fees, American Arbitration Association,
http://www.adr.org/archiverules (last visited June 3, 2024).
26 CAREMARK V. CHOCTAW NATION
at 419 (quoting Am. Arb. Ass’n, Construction Industry
Dispute Resolution Procedures R-48(c) (Sept. 1, 2000)).
Thus, the Court concluded that “the Tribe agreed, by
express contract, to adhere to certain dispute resolution
procedures,” id. at 420, and the arbitration clause
“memorialize[d] the Tribe’s commitment to adhere to the
contract’s dispute resolution regime,” id. at 422. The Court
rejected the tribe’s argument that the arbitration agreement
did not waive its immunity for judicial enforcement of the
arbitration award specifically. Id. The Court explained that
the dispute resolution regime agreed to by the parties “has a
real world objective; it is not designed for regulation of a
game lacking practical consequences.” Id. In other words,
“[t]he arbitration clause . . . would be meaningless if it did
not constitute a waiver of whatever immunity [the Tribe]
possessed.” Id. (second alteration in original) (quoting
Native Vill. of Eyak v. GC Contractors, 658 P.2d 756, 760
(Alaska 1983)).
To be sure, the procedural context in C & L Enterprises
differed from this case. There, the Court was deciding
whether the tribe had waived its immunity from suit to
enforce an arbitral award against it. Id. at 414. But the
Court’s reasoning applies with equal force to the issue
presented here: whether under the express terms of the
Provider Manuals—in which the Nation agreed to arbitrate
its disputes with Caremark and further agreed that any
arbitration “must be conducted in Scottsdale, Arizona and
Provider agrees to such jurisdiction”—the Nation waived its
immunity as to a motion to compel arbitration proceedings
brought in the District of Arizona, the jurisdiction where any
arbitration is to take place under the arbitration agreement.
Just as the arbitration provision in C & L Enterprises
embodied “the real world end” of “judicial enforcement of
CAREMARK V. CHOCTAW NATION 27
the resolution arrived at through arbitration,” id. at 422, the
arbitration clause here reflects the real world end of
permitting suit in a competent jurisdiction to initiate the
arbitration proceedings that the parties’ agreement otherwise
plainly allows.
Like the contract in C & L Enterprises, the incorporated
Provider Manuals here clearly and unambiguously waive the
Nation’s sovereign immunity from arbitration proceedings
in the District of Arizona. See id. at 418–19; see also id.
at 420–21 (concluding that the parties, through the
arbitration clause, unambiguously agreed to submit disputes
arising under a contract to arbitration, and rejecting the
suggestion that “to be deemed explicit” a waiver of
sovereign immunity “must use the words ‘sovereign
immunity’” because “[n]o case has ever held that”) (quoting
Sokaogon Gaming Enter. Corp. v. Tushie-Montgomery
Assocs., Inc., 86 F.3d 656, 659–60 (7th Cir. 1996)); Ninigret
Dev. Corp. v. Narragansett Indian Wetuomuck Hous. Auth.,
207 F.3d 21, 31 (1st Cir. 2000) (concluding that the forum-
selection clause was “nose-on-the-face plain” because it
committed “[a]ll claims, disputes and other
matters . . . arising out of or relating to [the contract] to
arbitration” (internal quotation marks omitted) (alterations
in original)). The Provider Agreements (through the
incorporated Provider Manuals) memorialized the Nation’s
commitment to the dispute resolution regime that the
agreements required, and that commitment came with
practical consequences: the Nation agreed that any
arbitration would take place “in Scottsdale, Arizona and
Provider agrees to such jurisdiction.”
The Choctaw Nation tries to avoid this conclusion by
arguing that C & L Enterprises is distinguishable because
there, “the Tribe itself had prepared the contract containing
28 CAREMARK V. CHOCTAW NATION
the arbitration provision.” Here, Caremark drafted the
Provider Agreements. But the identity of the party drafting
the contracts in C & L Enterprises was irrelevant to the
Court’s waiver analysis. See 532 U.S. at 423. Although the
Court pointed out that the tribe had proposed a “standard
form construction contract” and inserted “details not set out
in the form,” id. at 414–15, it did so only to dismiss the
tribe’s suggestion that a form contract could not waive tribal
sovereign immunity, id. at 423. The Court noted that “[i]n
appropriate cases,” when applying the common-law rule of
contract interpretation, ambiguous language in a contract
could be construed against the drafter. Id. However, the
Court explained that rule was “inapposite” because the
contract at issue was not ambiguous. Id.
The same reasoning defeats the Nation’s argument that
C & L Enterprises cannot apply here because Caremark
drafted the Provider Agreements and Manuals. Those
contracts are not ambiguous, and the Nation does not argue
otherwise or claim that it was forced into adhesion contracts.
Because there is no contractual ambiguity, the fact that the
Nation did not draft the Provider Agreements or Manuals is
irrelevant to whether it waived its sovereign immunity for
arbitration proceedings in Arizona, just as the fact that the
tribe drafted the contracts was irrelevant to the Court’s
waiver analysis in C & L Enterprises. See id. Thus, C & L
Enterprises compels the conclusion that the Nation
contractually waived its sovereign immunity for a motion to
compel arbitration in Arizona.
IV.
We conclude that the District of Arizona had jurisdiction
over Caremark’s petition to compel arbitration, and we
affirm the district court’s order compelling arbitration. In
CAREMARK V. CHOCTAW NATION 29
step with Chickasaw, we take no position on the
enforceability of the arbitration provisions because that issue
is delegated to the arbitrator. See 43 F.4th at 1034.
AFFIRMED.
Plain English Summary
FOR PUBLICATION UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT CAREMARK, LLC; CAREMARK No.
Key Points
01FOR PUBLICATION UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT CAREMARK, LLC; CAREMARK No.
02LLC; AETNA, INC.; AETNA 2:21-cv-01554- HEALTH, INC., SMB Plaintiffs-Appellees, v.
03OPINION CHOCTAW NATION; CHOCTAW NATION HEALTH SERVICES AUTHORITY; CHOCTAW HEALTH CARE, TALIHINA, OK; CHOCTAW NATION HEALTH CLINIC-RUBIN WHITE, POTEAU; CHOCTAW NATION HEALTH CLINIC- MCALESTER; CHOCTAW NATION HEALTH CLINIC-IDABEL; CHOCTAW NAT
04CHOCTAW NATION Appeal from the United States District Court for the District of Arizona Susan M.
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FOR PUBLICATION UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT CAREMARK, LLC; CAREMARK No.
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