DOI: 10.1097/01.COT.0000289612.95082.ca
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Issn Print: 0276-2234
Publication Date: 2003/02/25
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Excerpt
The program, Maine Rx, expands the rule that requires drug companies to discount drugs sold to state Medicaid programs. It requires drug makers to offer those same discounts to other low-income people in the state who, nevertheless, earn too much to qualify for Medicaid.
Non-cooperating companies could see the state remove its drugs from the list of those it pays for under Medicaid, forcing doctors who want to prescribe them to apply for prior authorization. The program has not yet started. An order by a federal district judge blocked it the day before it was to begin.
PhRMA called the plan unconstitutional, charging that Medicaid recipients would suffer because of delays in receiving medications they might require. Industry lawyers also argued that prior authorization is illegal because it preempts a federal law saying that any changes that hurt patients are illegal.
But lawyers for the state responded that the plan would be good for patients; that making drugs more affordable would help people remain healthy, keeping them out of poverty and out of Medicaid.
Several justices questioned whether the case should have been brought before the high court and suggested that it might be better to have it decided by a lower court or the Secretary of Health and Human Services.
One of the problems the justices noted is that the concept of Maine Rx has never been tried and may need to be played out before its success or failure can be determined. A decision is expected this summer.
While Maine awaits word on this plan to cut drug costs, it is moving ahead on yet another. Nine states and the District or Columbia have announced their intention to form a joint nonprofit organization to manage their drug benefit programs, replacing the private companies known as pharmacy benefit managers.
They hope to do a better, more cost effective job of putting together their drug formularies, aided by advice from medical experts. In addition to Maine, the other participating states are Connecticut, Hawaii, Massachusetts, New Hampshire, New York, Pennsylvania, Rhode Island, and Vermont.
