Magazine article Drug Topics

Maine Drug Discount Program Spurring Interest in Other States

Magazine article Drug Topics

Maine Drug Discount Program Spurring Interest in Other States

Article excerpt

Prescription drugs cost too much for those who lack coverage, and all too many senior citizens are forgoing theirs, to the detriment of their health. Attendees at a roundtable discussion at the annual meeting of the American Public Health Association in Boston got an earful of solid evidence supporting the common wisdom on this matter.

Attendees also got wind that the political tide may be turning toward coverage. When Maine Senate majority leader Chellie Pingree first set out to help seniors buy Rx drugs, it must have seemed like the specter of Don Quixote was loose in the legislature. She learned quickly that her opposition, the Pharmaceutical Research & Manufacturers of America (PhRMA), is omnipresent, its representatives showing up at even the smallest citizen meetings. Several years ago, she sought to boost the existing 15% Rx drug rebate for uncovered residents by an additional 6%. Late in the evening, she amended the budget for that purpose. "By nine the next morning, there were six representatives of the pharmaceutical industry sitting in my office," she told her audience. Nonetheless, that measure passed, but campaign finance money dried up.

Yet Maine recently passed a law effectively turning the state into a pharmaceutical benefit manager charged with reducing the cost of Rxs to levels commensurate with costs obtained by other large purchasers. Pingree has gained so much political capital that she announced at the roundtable that she will be running for governor in the next election.

Those pushing for passage of Maine Rx, as the new law is called, had Maine's 19th-century-scale demographics on their side. It is common for legislators and citizens to mix over breakfast at local diners, said Pingree. This made it easier for legislators supporting the bill to seek public support and for the public's voice to echo loudly in the halls of the legislature.

"It wasn't just lowincome seniors, but seniors of all different income levels, who were very embarrassed thinking that their nest egg would get them by, and finding that an illness took it," said Pingree. And adult children and doctors got worried that their parents and their patients weren't filling their prescriptions.

"A lot of people were uncomfortable meddling in business," said Pingree. "But we argued that this is not a free market but a highly controlled industry I often argued to doctors that doctors in our state are lucky to get 50% of their costs under Medicaid."

The law passed unanimously in the Maine Senate, and all but 11 members of the House voted in its favor. A poll of doctors last summer found 80% support, "and doctors don't tend to favor price controls," said Pingree.

The law, which was signed last May 11, directs the state to negotiate with participating drug manufacturers "an initial rebate amount equal to or greater than the rebate calculated under the Medicaid program." The rebate would go to the estimated 325,000 of Maine's million residents who lack coverage for drugs, via their pharmacies. The pharmacies would receive $3 for every prescription filled within the program. The law also requires prior authorization of drugs provided by manufacturers that do not participate under the Medicaid program. This is a big stick, since prior authorization reduces sales typically by around 60%, said Kevin Concannon, commissioner of Health & Human Services for the state.

The program also established a 12member commission to review prices. Manufacturers or distributors charging excessive prices or otherwise restricting access could be fined up to $100,000. …

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