|
Friday, November 26, 2004
Maine Rx Plus works to increase discounts
Copyright © 2004 Blethen Maine Newspapers Inc. | ||||||
 |
Also on this page: In Depth: Health Care Reform | |||||
Maine Rx Plus is on the verge of increasing discounts for residents who don't have prescription drug coverage - though not in a way originally envisioned by creators of the nearly year-old program. The state says it is talking with 20 drug companies about offering discounts of 5 percent to 10 percent on top of the savings already being offered by pharmacies - 15 percent for brand-name products and as much as 60 percent for generics. Pending negotiations, state officials refused to name the companies, which produce a total of 200 drugs, but they said they hope to make the additional discounts available in January. 'CARROT' VS. 'STICK' Health care observers are calling the negotiations a "carrot" approach, rather than the "stick" that brought the program the wrath of the pharmaceutical industry and acclaim from other states that are frustrated by rising prescription costs. A provision in the Maine Rx Plus law allows the state to force discounts from drug manufacturers by making it harder for their products to reach the lucrative market created by MaineCare, the government insurance program for the poor and disabled. The measure is known as "prior authorization." It requires doctors to get state approval before prescribing certain drugs to any of Maine's 260,000 Medicaid patients. In the case of Maine Rx Plus, prior authorization could be required for drugs made by companies that refuse to discount. This riles the drug industry's trade association, which successfully stalled the program in the courts until last year by arguing that Maine could use its most vulnerable residents to leverage discounts for people who are better off. But the state has refrained from using this tool, largely, it says, because it doesn't have to use it. In the years since the drug discount program was created, prior authorization has become common in MaineCare. A PREFERRED LIST OF DRUGS To rein in runaway prescription costs in MaineCare, the state in January 2001 made up a list of quality drugs deemed cost-effective in 14 categories. If a doctor wanted to prescribe a drug that was off the list, prior authorization was necessary. In July 2003, the state expanded the preferred list to more than 5,000 drugs in 200 categories. A clinical review established which drugs were the best. If similar drugs were deemed of equal quality but not of equal cost, then companies were given a chance to provide discounts on top of those mandated by federal law and get their drugs on the list. By this spring, as the state planned to negotiate discounts for Maine Rx Plus for the same drugs preferred in MaineCare, some of those companies that provided extra rebates in MaineCare showed interest, said Jude Walsh, who oversees pharmacy affairs for the Governor's Office of Health Policy and Finance. "I think two years ago, we wouldn't have been able to envision the pharmaceutical companies coming to the table to work with us," Walsh said. "This is voluntary. We're working with the companies that seem to want to work with us anyway." MORE DISCOUNTS, MORE SALES Increasing market share is a leading incentive for drug makers to offer more discounts, Walsh said. An estimated 275,000 people are eligible for Maine Rx Plus - more than a fifth of the state's population - because they earn less than 3.5 times the federal poverty level and lack prescription drug coverage. So far, 99,000 people are enrolled. Drug companies also are aware that physicians tend to prescribe the same brands of drugs across their patient base, Walsh said, and may lean toward products known as drugs of choice in various programs. "It's really a matter of continuing that preferred status among all of Maine's drug programs," Walsh said. Despite the state's announcement that it would not use prior authorization without federal approval, the drug industry's largest trade group, Pharmaceutical Research and Manufacturers of America, says it will not rest easy. PhRMA argued on Sept. 9 in federal court in Providence, R.I. - judges in Maine had recused themselves from the case - that the state must go to the federal Centers for Medicare and Medicaid for a decision on the program, even if it has no plans to use prior authorization now. A PLEA FOR CERTAINTY "Just because their behavior and enactment of the statute has changed, doesn't mean the statute has changed. They can go back and change their mind again," said Wanda Moebius, PhRMA's spokeswoman. "We just need clarity and certainty for their commitment, versus the 'Trust me' factor." The state made a motion to dismiss the case on the grounds that there is no controversy remaining, said Newell Auger, spokesman for the state Department of Health and Human Services. A decision is expected as early as this month. PhRMA halted for three years an earlier version of Maine Rx Plus that focused on prior authorization as a bargaining tool. The U.S. Supreme Court lifted an injunction on the program, saying PhRMA did not show why it should be blocked, and sent it back to federal district court for review. The state, meanwhile, added an income cap and asked pharmacists to provide the initial discounts. The retooled program began in mid-January. Arn Pearson, executive director of the nonprofit Maine Citizen Leadership Fund, which helped to defend the original Maine Rx in court, didn't fault the state for shelving prior authorization. "As long as they haven't conceded their ability to use prior authorization under Maine Rx and they are negotiating discounts through different means, we're probably OK," Pearson said. Pearson said prior authorization could be used if the marketplace changes. "If, in the future, they decide they weren't getting the kind of discounts that they want and if some of the major drug companies decided they weren't going to play ball in the same way, then they retain their leverage and can take a harder line on things." Current discounts are made possible by the participation of more than 100 pharmacies. Major pharmacy chains like Rite Aid and CVS, however, have opted out of the program, saying tight profit margins don't allow them the luxury of providing discounts to people who would otherwise pay full retail price. Staff Writer Josie Huang can be contacted at 791-6364 or at:
|
||||||