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Saturday, January 3, 2004
New Medicare drug coverage stalls state's discount plan
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Medicare reform has inadvertently delayed a plan to provide discounted medicine to thousands of Mainers who lack drug coverage but make too much money to get traditional government assistance. Maine Rx Plus, initially set to start Jan. 1 and help 275,000 Mainers, is on indefinite hold as the state figures out how its program will co-exist with the new Medicare prescription drug benefit. That coverage, though limited, will be offered to senior citizens and some disabled individuals for the first time in the federal program's 38-year history. Officials in Gov. John Baldacci's administration say an array of unforeseen scenarios have arisen, including this one: Someone who joins Maine Rx Plus while earning less than 135 percent of the federal poverty level - the state program accepts those living within 350 percent of poverty - could also qualify for a free $600 annual Medicare subsidy for prescription drugs for the next two years. One of the state's tasks is to identify the thousands of "dual-eligibles" among Maine Rx Plus enrollees, then see how the state and the individuals can benefit from federal funds. "We want to make sure the person gets the $600 before we spend any (state) money," said Trish Riley, the governor's director of health policy and finance. "It's an administrative negative," she said of the Medicare complications. "But it's not all negatives." Because the Medicare drug benefit was passed by Congress in late November and information is only beginning to trickle out, Riley and her staff have posed numerous questions to federal officials in conference calls that have lasted as long as three hours: How great will the Medicare benefit be? What drugs will it cover? How does this compare to Maine Rx Plus? Will seniors have to carry multiple cards to access discounts for different drugs? With so many unknowns, Riley said it's unclear when Maine Rx will be launched, though she predicted it will be "soon." Lawmakers are pushing for quick action. Senate Majority Leader Sharon Treat said she is eager to see Maine Rx Plus operating because constituents have told her they are putting off drug purchases until they can get Medicaid-like discounts from the program. "My hope is by the end of January it could be up and running," said Treat, D-Farmingdale, who was briefed by Riley about Maine Rx Plus on Friday afternoon. The delay of Maine Rx Plus is just the latest hurdle for a program that has undergone numerous changes and faces continuing legal battles. The program was born in 2000 as Maine Rx, and the state captured national attention for threatening to punish drug companies that refused to provide discounts for the program. The state planned to put the products of uncooperative companies on a special list of drugs requiring doctors to seek "prior authorization" before prescribing them for Medicaid patients, a market that drug companies count on. The trade group Pharmaceutical Research and Manufacturers of America successfully stalled the initial program in court, arguing that Maine was using the poor to extract discounts for better-off Mainers. But the U.S. Supreme Court decided there was not enough reason to halt the program. It lifted an injunction on May 19, 2003, and sent the law back to U.S. District Court in Portland for review on its merits. PhRMA has not sought another injunction, but on Wednesday it filed a motion requesting that the court seek the opinion of the secretary of the federal Department of Health and Human Services about the program, according to Assistant Attorney General John Brautigam. No one from PhRMA, whose offices were closed Friday, could be reached for comment. The Baldacci administration has since renamed the program Maine Rx Plus and softened features to protect it from future legal action. The changes included eliminating open enrollment and adding the income-eligibility cap. In its first phase, the program will offer Medicaid-like discounts as high as 60 percent off the retail price of generic drugs and 15 percent off brand-name drugs. This phase has upset the Maine Pharmacy Association because it says Maine's pharmacies, which operate on a 1 percent to 2 percent profit margin, will have to swallow the cost of providing the discounts. The pharmaceutical industry has no problem with that part of the program. But it continues to protest the state's plan to use prior authorization to negotiate even deeper discounts for the second phase. The state's enthusiasm for this controversial part of the plan, however, appears to have cooled, even though that's what set it apart from all other drug discount programs. "I think we can do phase two . . . but I'm not sure we will," Riley said Friday. Staff Writer Josie Huang can be contacted at 791-6364 or at:
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