With the new, even more narrowly divided Congress unlikely to achieve a quick consensus on a Medicare drug benefit, more states will consider their own legislation to help seniors buy medicines next year. Assistance programs, primarily for the low-income elderly and disabled who do not qualify for Medicaid, are on the books in 22 states. New ones began operating this year in California, Delaware, Maine, Nevada, New Hampshire, and North Carolina. Sparked by the availability of tobacco settlement funds, new programs or major expansions in eligibility were enacted in Indiana, Kansas, Florida, South Carolina, Illinois, Massachusetts, New York, and Rhode Island, the National Conference of State Legislatures said. Most of the changes take effect next year
One of the most popular pieces of legislation in 2001 will be modeled on the approach Maine approved last May, Despite a legal cloud over that model, lawmakers in at least 26 states have indicated they'll follow Maine's lead, according to the National Wholesale Druggists' Association. Maine wants to negotiate rebates with manufacturers for prescription drugs purchased by residents without Rx insurance. The rebates would go into the Rx Fund to reimburse pharmacies. Manufacturers who decline to participate would have their Rxs put on the prior-authorization list for Medicaid. In 2003, an emergency pricing board could require companies to provide rebates/discounts that make prices comparable to those in Canada or on the Federal Supply Schedule as a condition of selling any Rxs in Maine.
"The interest is phenomenal," said Maine state senator Chellie Pingree (D), who was the driving force behind the law. "We can't answer all the phone calls, and go to all the meetings, and offer enough assistance to all the people and all the states that want to do it."
But on Oct. 26, U.S. District Judge D. Brock Hornby issued a preliminary injunction sought by the Pharmaceutical Research & Manufacturers of America that blocks most of the law from taking effect Jan. 1. Hornby found PhRMA's "likelihood of success on the merits of most of its Constitutional challenges to be overwhelming." Maine attorney general Andrew Ketterer on Nov. 9 petitioned the First U.S. Circuit Court of Appeals to lift the injunction. No date for a hearing has been set. (For more on the Maine program, see page 82.)
Another model likely to be offered by state legislators comes from Callfornia. Medicare beneficiaries there can buy Rxs at pharmacies at the same prices pharmacies are reimbursed for in MediCal, the Medicaid program. …