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Wednesday, January 14, 2004
Maine Rx Plus set to start
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Starting Saturday, thousands of income-eligible Mainers without drug coverage can buy cheaper prescriptions at select pharmacies. Through Maine Rx Plus, an estimated 275,000 people can get discounts ranging between 10 and 25 percent for brand-name drugs, and about 60 percent for generics, state officials announced Tuesday. Supporters of Maine Rx Plus say similar drug assistance programs in other states cannot rival its savings and inclusiveness. People who make more than three times the federal poverty level qualify for savings. But some Mainers may have to switch pharmacies to reap its benefits. About 110 stores have signed up for the program, including those run by grocery stores Hannaford and Shaw's. But another 100 or so - operated by drugstore chains like Rite Aid, CVS and Community Pharmacies - have opted out for now. The chains say their pharmacies, some of the most popular in Maine, can't afford to offer Medicaid prices to even more people in the face of low profit margins and impending Medicaid reimbursement cuts. Gov. John Baldacci's administration, however, says there is enough pharmacy participation around the state to make Maine Rx Plus a success. "We wouldn't have started it if we didn't think it would work," said Trish Riley, director of the governor's Office of Health Policy and Finance. Maine Rx Plus gives the same kind of savings seen in the state's Medicaid program to people who make too much money to qualify for government assistance, but can't afford prescription drug coverage. This population has not seen state assistance for drug costs since the pharmaceutical industry stopped the Healthy Maine Prescriptions assistance program from offering Medicaid-like discounts more than a year ago. More than 70,000 people were dropped from Healthy Maine in December 2002 after the U.S. Court of Appeals in Washington said it was an illegal expansion of Medicaid. Maine Rx Plus is different because it relies on state statute, rather than a federal Medicaid waiver, to offer savings. Baldacci announced Tuesday that the state has already mailed thousands of Maine Rx Plus membership cards to former Healthy Maine members, drawing applause at a press event at the Hall of Flags in Augusta, heavily attended by Democratic lawmakers and consumer advocates. Joe Ditre, executive director of Consumers for Affordable Health Care, said the program is commendable for casting a blind eye toward age and accepting individuals who make within 350 percent of the federal poverty level. The maximum income amount is $31,440 for an individual; $42,420 for a couple and $64,400 for a family of four. It's unclear whether state officials will implement the second, highly controversial phase of the program aimed at obtaining even deeper discounts for Maine Rx Plus. State statute authorizes state officials to punish drug companies that refuse to provide the discounts by placing their products on "prior authorization" lists. That means doctors would have to get state approval before prescribing any of the products on the list to Medicaid patients, a market that drug companies depend on. This provision of the program stalled an earlier version of Maine Rx Plus, called Maine Rx, for three years. The country's most powerful pharmaceutical trade group, Pharmaceutical Manufacturers and Research of America, argued that the Maine was using its poorest citizens to help those who were better off. The U.S. Supreme Court lifted an injunction on the program, saying PhRMA did not adequately show why it should be blocked, and sent it back to U.S. District Court in Portland for review of its merits. In the meantime, the state eliminated open enrollment, added the income cap and renamed it Maine Rx Plus. With the case still pending in court, state officials have said they have not decided whether to pursue "prior authorization" as a bargaining chip. But consumer groups and one of the co-sponsors of the original version of Maine Rx Plus said they wanted to see the state take a stand against drug companies. "We should negotiate on price," said former Speaker of the House Mike Saxl, who is now advising Hawaii's state government on a program modeled after Maine Rx. "I hope they go through with phase two." The National Legislative Association on Prescription Drug Prices said the savings offered by the Maine Rx Plus in its initial phase already outpaces most of the country. "This will be hands-down, one of the most superior programs," said Cheryl Rivers, executive director of the Vermont-based association, which is working with nine states, including Maine, on projects to bring down drug costs. But Rivers said consumers should still shop around for lower prices by looking to Canada, where drugs are cheaper because of government price controls and a favorable exchange rate. State officials say Maine Rx Plus is starting more than two weeks after the planned Jan.1 launch date because they needed to coordinate the program with the newly authorized Medicare drug benefit. Riley, the health policy and finance director, said that major kinks have since been worked out. For example, the state will ask individuals eligible for a $600 Medicare subsidy to use that sum before tapping into Maine Rx Plus, or an existing program called Drugs for the Elderly. Staff Writer Josie Huang can be contacted at 791-6364 or at: jhuang@pressherald.com |
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