An Act To Improve the Maine Rx Program
Maine Legislature, Session 121, LD 1634
Committee: Health and Human Services
Sponsors: TREAT, KANE, BRENNAN, MAYO, TURNER, LEMOINE, RICHARDSON
Amends: 22 MRSA §2681, 22 MRSA §2682, 22 MRSA §2693

12lst MAINE LEGISLATURE 
Legislative Document 
No. 1634 
S.P.590 
In Senate, June 11,2003 
An Act To Improve the Maine Rx Program 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
Presented by Senator TREAT of Kennebec. (GOVERNOR'S BILL) 
Cosponsored by Representative KANE of Saco and 
JOY J. O'BRIEN 
Secretary of the Senate 
Senators: BRENNAN of Cumberland, MAYO of Sagadahoc, TURNER of Cumberland, 
Representatives: LEMOINE of Old Orchard Beach, RICHARDSON of Brunswick. 
Printed on recycled paper 
Be it enacted by the People of the State of Maine as follows: 
Sec. I. 22 MRSA c. 603, sub-c. I is amended by repealing the 
subchapter headnote and enacting the following in its place: 
SUBCBAP'l'ER 1 
MAIRE RX PLUS PIlQGRAM 
Sec. 2. 22 MRSA §2681, as amended by PL 2001, c. 358, Pt. Q, 
§6 and c. 405, 
§2 and affected by §3, is further amended by 
repealing the section headnote and enacting the following in its 
place: 
§268l. Maine b 
Plus Program established 
Sec. 3. 22 MRSA §2681, first" as enac ted by PL 1999, c. 786, 
Pt. A, §3, is amended to read: 
The Maine Rx ~ 
Program, referred to in this subchapter as 
the "program," is established to reduce prescription drug prices 
and to improve the quality of health care for residents of the 
State. 
The program is Qes~~aeQ-~~-~~~~-~e administered by 
the department and must utilize manufacturer rebates and pharmacy 
discounts to reduce prescription drug prices. 
~a--HAp-leRI&a~i-a~ 
~Re-p£e~~~-~~~~~-&aa~~-SeFve-a£-~~~-9&a&~i-~-maaa~eF 
~a-~~~i-&ai-~-~~~-a£~-Q~see~a~s-~&-~-~--~~a*i-~i-eQ 
Fes~QeatsT 
Sec. 4. 22 MRS A §2681, sub-§§I, 2, 4, 5 and 6, as enacted by PL 
1999, c. 786, Pt. A, §3, are amended to read: 
1. 
Prograa goals. 
The Legislature finds that affordability 
is critical in providing access to prescription drugs for Maine 
residents. 
This subchapter is enacted by the Legislature to 
enable the State to 
ae~--as--a-ph~ma£j'--bene-f-i-t,.-maaa~e~--l,.n..-eFQeF 
take 
steps 
to 
make 
prescription 
drugs 
more 
affordable 
for 
qualified Maine residents, thereby increasing the overall health 
of Maine residents, promoting healthy communities and protecting 
the public health and welfare, and to integrate the program as 
part of any statewide program for the uninsured. 
It is not the 
intention of the State to discourage employers from offering or 
paying for prescription drug benefits for their employees or to 
replace employer-sponsored prescription drug benefit plans that 
provide benefits comparable to those made available to qualified 
Maine residents under this subchapter. 
2. 
Definitions. 
As used 
context 
otherwise 
indicates, 
following meanings. 
in 
the 
this subchapter, 
following 
terms 
Page l-LR2l73(1) 
unless 
have 
the 
the 
A. 
"Average wholesale price" means 
the wholesale price 
charged on a specific commodity that is assigned by the drug 
manufacturer and is listed in a nationally recognized drug 
pricing file. 
A 1. 
"Covered drugs" means drugs that are on the MaineCare 
preferred drug list established and revised from time to 
time by the department pursuant to its authority to operate 
the MaineCare program. 
B. 
"Initial discounted price" for a drug means a-pE:i:ee-~Ra~ 
is-~e££-~~~-~Qa~-t9-~he-~~~~~-p~ie&r-miR~s 
&%T-~~a&-~~-Qi£peB£~~-'ee-~~~iG&G-~--~~-MeQiea:i:Q 
pE9~Eam--~RQeE--tR:i:s--~:i:tle the price the department pays 
MaineCare participating retail pharmacies for that drug for 
MaineCare members. 
C. 
"Labeler" 
means 
an entity or 
person that 
receives 
prescription drugs from 
a 
manufacturer or wholesaler and 
repackages those drugs for later retail sale and that has a 
labeler code from the federal Food and Drug Administration 
under 21 Code of Federal Regulations, 207.20 (1999). 
D. 
"Participating retail pharmacy" 
or "retail pharmacy" 
means a retail pharmacy located in this State, or another 
business licensed to dispense prescription drugs in this 
State, that participates in the program aRQ--t.-hat:--pE9viees 
eise9~RteQ-pEiees-t9-EesieeRts-as-pEevieee-:i:R-saeseet:i:9R-§. 
ET--!!PRaEmaey-~e-f~~-~.!'--means--an-~&'="i-,="y-tAat-pEge~Ees 
pEeseEipti9R-eE~~s-at-a-Be~9t:i:at9Q-Eate-~BQeE-a-e9BtEaetT 
F. 
"Qualified resident" means a resident of the State who 
has getaiBeQ-.f-£'-em- -t.~ 
-4ep&~1::ffie.&,=" - a - Ma.-i-ae-~ 
-ea-~~lrfteB.'=" -e aEQ 
a family income equal to or less than 350'1t> of the federal 
poverty 
level 
and 
who 
is 
enrolled 
in 
the 
program. 
"Qualified resident" also means 
a 
resident of the State 
whose family incurs unreimbursed expenses for prescription 
drugs that equal 5'1t> or more of family income or whose total 
unreimbursed medical expenses equal 15'1t> or more of family 
income. 
For purposes of this paragraph, the cost of drugs 
provided under this subchapter is considered an expense 
incurred 
by 
the 
family 
for 
eligibility 
determination 
purposes. 
G. 
"Secondary discounted price" means 
a-~~-€e--tJla.t,--i-s--e4!~al 
t9-~~--~-~~-~Re--iBitial-~~-~~~-mi-a~£--tRe 
am9~Bt-e.f-~~~-paid-ey-~he-~~~-t.~-&A&-paEt:i:e:i:patiB~ 
~etail--pha~maey the initial discounted price minus 
any 
further discounts paid for out of the fund. 
4. 
Rebate amount. 
The 
commissioner shall negotiate the 
amount of the rebate required from a manufacturer or labeler in 
accordance with this subsection. 
A. 
The 
commissioner 
shall 
take 
into consideration the 
rebate calculated under the Medicaid Rebate Program pursuant 
to 
United States Code, 
Section 1396r-8, 
the average 
wholesale 
price 
of 
prescription 
drugs 
and 
any 
other 
information on prescription drug prices and price discounts. 
B. 
The 
commissioner 
shall 
use 
the 
commissioner's best 
efforts to obtain an initial rebate amount equal to or 
greater 
than 
the 
rebate 
calculated 
under 
the 
Meaieaia 
MaineCare program pursuant to 42 United States Code, Section 
1396r-8. 
C. 
With respect to the rebate taking effect no later than 
October 
1, 
aggl 
~, the 
commissioner 
shall 
use 
the 
commissioner's best efforts to obtain an amount equal to or 
greater than the amount of any discount, rebate or price 
reduction for prescription drugs provided to the Federal 
Government. 
5. 
Discounted prices for qualified residents. 
Aay Each 
participating retail 
pharmacy 
that--6ells--p£e6eFiptiea--aFQ~S 
eeyeFea-~-~-Fe9ate-~-~~~--te-~~-~-shall 
aiseeQat--the--~~~~-~r~-~-~~-~~-£ele--~e--~Qali~iea 
Fesiaeats shall sell covered drugs to gualified residents at the 
lower 
of 
the 
initial 
discounted 
price 
and 
the 
secondary 
discounted price as such prices are determined by the department 
pursuant to this subchapter. 
A. 
The department shall establish discounted prices for 
drugs covered by a rebate agreement and shall promote the 
use 
of efficacious 
and 
reduced-cost 
drugs, 
taking into 
consideration reduced prices for state and federally capped 
drug programs, differential dispensing fees, administrative 
overhead and incentive payments. 
B. 
Beginning January 1, aggl ~, a participating retail 
pharmacy shall offer the initial discounted price. 
C. 
No later than October 1, 
aggl 2..QQ!, 
a participating 
retail pharmacy shall offer the secondary discounted price 
if ayailable. 
gT---~&-~~~-~~-ameQB~-~~-~~-p£4€e67--~Re 
aepa~EmeB~-6Aa~~-€eB644e£-~~~~~~~-F&&a~&-p~eviaea 
PQFSQaB~-~e-~~ee~4~~-~~~~~~~-QF~&-SQ&;ee~ 
~e-~~-F&&a~&-~e£--~-ffi&6~-~-~~-meB~A-~~-ieF 
wRieR-~Re-iBieFma~ieB-is-availaaleT 
6. 
Operation 
of 
proqraa. 
The 
requirements 
of 
this 
subsection apply to participating retail pharmacies. 
A. 
The Maine Board of Pharmacy shall adopt rules requiring 
disclosure by participating retail pharmacies to qualified 
residents of the amount of savings provided as a result of 
the 
program. 
The 
rules 
must 
consider 
and 
protect 
information that is proprietary in nature. 
Rules adopted 
pursuant to this paragraph are routine technical rules as 
defined in Title 5, chapter 375, subchapter II-A 2-A. 
B. 
The department may not impose transaction charges under 
this program on retail pharmacies that submit claims or 
receive payments under the program. 
C. 
A participating retail pharmacy shall submit claims to 
the department to verify the amount charged to qualified 
residents under subsection 5. 
D. 
On 
a 
weekly or biweekly basis, 
the department must 
reimburse a participating retail pharmacy for the difference 
between 
the initial discounted price 
and 
the 
secondary 
discounted pFiees price provided to qualified residents 
under subsection 5 aBa-p£e~e664eBaJ-~~7-~~~-&&-set 
ay-tae-€emmissieBeF. 
~ae-am9~B~-~-~~-~~~~~-pFeiessieBal 
fee-mQst-ae-set-at-$6-peF-pFeseFip~ieBT 
ET--~~~~~&~-6AaJJ-~~--Q~i~i~a~i9B-Q~~~-tRe 
paFtieipatiB~-~~~~--~ha~i&&-~~hm4~~4B~-~~~-BeeessaFY 
te-€a~€~~a~~~~~-ei-tAe-~~~~~~-&A&-maBQiaetQ~eF 
eF----~~r----~~---aepaFtmeBt---~~~---~~~----tae 
eeBfiaeBtiality----9~----~~-----inf~~~----&~&}ee&----te 
eeBfiaeBtiality-~~~~4~~--s~a&&-eF-~~~--~r-FQle 
eF-Fe~QlatieBT 
F. 
The department shall conduct ongoing quality assurance 
activities similar to those used in the MaineCare program. 
Sec. 5. 22 MRSA §2681, sub-§7, as enacted by PL 1999, c. 786, 
Pt. A, §3 and amended by PL 2001, c. 405, §2 and affected by §3, 
is repealed and the following enacted in its place: 
7. 
Action with regard to noaparticipating eanutacturers and 
labelers. 
The names of manufacturers and labelers who do not 
enter into rebate agreements pursuant to this subchapter are 
public 
information. 
The 
department 
shall 
release 
this 
information 
to 
health 
care 
providers 
and 
the 
public. 
The 
department shall impose prior authorization requirements in the 
MaineCare 
program. 
as 
permitted by 
law. 
to 
the extent 
the 
department determines it is appropriate to do so in order to 
encourage manufacturer and labeler participation in the program 
and so long as the additional prior authorization requirements 
remain consistent with the goals of the MaineCare program and the 
requirements of the federal Social Security Act, Title 19. 
This subsection is repealed when subsection 7-A takes effect. 
Sec. 6. 22 MRSA §2681, sub-§7-A is enacted to read: 
A. 
ActioD with regard to DOu.participatiug IMDufacturers 
and labelers. 
The names of manufacturers and labelers who do and 
do not enter into rebate agreements pursuant to this subchapter 
are 
public 
information. 
The 
department 
shall 
release 
this 
information to health care providers and the public on a regular 
basis 
and shall publicize participation by manufacturers 
and 
labelers that is of particular benefit to the public. 
The 
department shall impose prior authorization requirements in the 
MaineCare 
program, 
as 
permitted by 
law, 
to 
the extent 
the 
department determines it is appropriate to do so in order to 
encourage manufacturer and labeler participation in the program 
and so long as the additional prior authorization requirements 
remain consistent with the goals of the MaineCare program and the 
requirements of the federal Social Security Act, Title 19. 
This subsection takes effect on the date that the department 
begins offering prescription drug benefits under the program. 
Sec. 7. 22 MRSA §2681, sub-§8, as enacted by PL 1999, c. 786, 
Pt. A, §3, is repealed. 
Sec. 8. 22 MRSA §2681, sub-§9, as amended by PL 2001, c . 358, 
Pt. Q, §6, is amended to read: 
9. 
Dedicated fund. 
The 
Maine 
Rx 
Plus Dedicated Fund, 
referred to in this section as the "fund," is established to 
receive revenue from manufacturers and labelers who pay rebates 
as provided in subsection 4 and any appropriations or allocations 
designated for the fund. 
The purposes of the fund are to. 
reimburse retail pharmacies for discounted prices provided to 
qualified residents pursuant to subsection 5; to reimburse the 
department 
for 
contracted services 
including pharmacy 
claims 
processing fees, 
administrative and associated computer costs T 
p~9fessi9Bal-~-~~-e9-~~~~~~-~~~4--pRa~maeies and 
other 
reasonable 
program costs; 
and 
to benefit the elderly 
low-cost 
drug 
program 
under 
section 
254. 
The 
fund 
is 
a 
nonlapsing dedicated fund. 
Interest on fund balances accrues to 
the fund. 
Surplus funds in the fund must be used for the benefit 
of the program. 
Notwithstanding Title 5, section 1585, surplus 
funds 
may 
also be transferred to the elderly low-cost drug 
program established under section 254. 
Sec. 9. 22 MRSA §2682, as amended by PL 2001, c. 471, Pt. E, 
§§5 to 7 and affected by §8, is further amended by repealing the 
section headnote and enacting the following in its place: 
52682. 
Disp1ay of Maine HI P1us Program participation infonaation 
Sec. 10. 22 MRSA §2693, sub-§l, ,.,A and B, as enacted by PL 
1999, c. 786, Pt. A, §3, are amended to read: 
A. 
By July 1, 
aQQa ~, the department shall adopt rules 
establishing the procedures for adoption and periodic review 
of maximum retail prices, the procedures for establishing 
maximum retail prices for new prescription drugs and for 
reviewing maximum retail prices of selected drugs and the 
procedures for phasing out or terminating maximum retail 
prices. 
Prior to adopting rules pursuant to this paragraph, 
the 
commissioner 
shall 
consult 
with 
and 
consider 
the 
recommendations of the commission regarding the rules. 
B. 
By 
January 
5, 
aQQ~ 
lQQQ, 
the 
commissioner 
shall 
determine whether the cost of prescription drugs provided to 
qualified residents under the Maine Rx Plus Program pursuant 
to subchapter 
~ 1 is reasonably comparable to the lowest 
cost paid for the same drugs delivered or dispensed in the 
State. 
In 
making 
this 
determination 
the 
following 
provisions apply. 
(1) 
The commissioner shall review prescription drug 
use in the Meeieaie MaineCare program using data from 
the 
most 
recent 
6-month period for 
which 
data is 
available. 
( 2 ) 
Using the data reviewed in subpar agr aph ( 1), the 
commissioner shall determine the 100 drugs for which 
the most units were provided and the 100 drugs for 
which the total cost was the highest. 
(3 ) 
( 2 ) , 
drug 
drugs 
date. 
For each prescription drug listed in subparagraph 
the commissioner shall determine the cost for each 
for qualified residents who are provided those 
under the Maine Rx tlYA Program on a certain 
The average cost for each such drug must be 
calculated. 
(4) 
For each prescription drug listed in subparagraph 
(2), the commissioner shall determine the lowest cost 
for each drug paid by any purchaser on the date that is 
used for subparagraph (3) delivered or dispensed in the 
State, 
taking into consideration the federal 
supply 
schedule and prices paid by pharmaceutical benefits 
managers and by large purchasers and excluding drugs 
purchased 
through 
the 
Maine 
Rx 
Plus 
Program. 
The 
average cost for each such drug must be calculated. 
(5) 
If the average cost for one or more prescription 
drugs under the Maine Rx Plus Program as determined in 
subparagraph (3) is not reasonably comparable to the 
average lowest cost for the 
same 
drug or drugs as 
determined in subparagraph (4), the commissioner shall 
establish 
maximum 
retail 
prices 
for 
any 
or 
all 
prescription 
drugs 
sold 
in 
the 
State. 
Maximum 
prescription 
drug 
prices 
established 
under 
this 
subparagraph must take effect July 1, 6QQa 2006. 
Sec. 11. PL200l,c.405,§3 is amended to read: 
Sec. 3. Effective date. 
This Act takes effect on the date that 
the Department of Human Services begins offering prescription 
drug 
benefits 
under 
the 
Maine 
Rx 
Plus 
Program 
as 
aefiaea 
established in the Maine Revised Statutes, Title 22, section 2681. 
Sec. 
12. 
Appropriations 
and 
allocations. 
appropriations and allocations are made. 
BONAR SERVICES, DEPAR7MERT OF 
Maine b 
Plus Proqraa 
The 
following 
Initiative: 
Appropriates 
funds 
for 
the 
following 
unfunded 
positions 
for 
which 
a 
position 
count 
has 
already 
been 
established: 
one Social Services Program Manager position, one 
Comprehensive Health Planner II position, one Financial Analyst 
position, one Senior Medical Claims Adjuster position and 2 Clerk 
Typist III positions. 
It also appropriates funds for necessary 
operating costs, including outreach activities, claims management 
services 
and 
for 
costs 
associated 
with 
the 
issuance 
of 
prescription cards. 
General Fund 
Personal Services 
All Other 
2003-04 
$172,022 
627,978 
2004-05 
$344,044 
1,655,956 
General Fund Total 
BOMAN SERVICES, DEPAR7MERT OF 
DEPAK".rIIEI!IT '1OrALS 
GENERAL FORD 
DEPARTMERT '1"O'.rAL -
ALL FORDS 
PROFESSIONAL ARD FIRABCIAL 
REGULATION, DEPAR'.I:MERT OF 
Licensinq and Enforcement 
$800,000 
$2,000,000 
2003-04 
2004-05 
$800,000 
$2,000,000 
$800,000 
$2,000,000 
Initiative: 
Provides for the appropriation of funds for the 
costs associated with the Maine Board of Pharmacy to adopt rules 
associated with the Maine Rx Plus Program. 
General Fund 
All Other 
General Fund Total 
PROFESSIONAL ARD FIRABCIAL 
REGULATION, DEPAR".DmRT OF 
DEPARTMEBT '1"O'.rALS 
GENERAL FORD 
DEPAR'1MERT '1"O'.rAL -
ALL FORDS 
SECTION '1"O'.rALS -
ALL FORDS 
SUMMARY 
2003-04 
$0 
$0 
2003-04 
$0 
$0 
$800,000 
2004-05 
$2,500 
$2,500 
2004-05 
$2,500 
$2,500 
$2,002,500 
This bill changes the name of the Maine Rx Program to the 
Maine Rx Plus Program. 
It defines "covered drugs" in the Maine 
Rx Plus Program to mean drugs that are on the MaineCare preferred 
drug list established by the Department of Human Services. 
It 
changes the definition of "qualified resident" for the Maine Rx 
Plus Program to mean a resident of the State who has a family 
income equal to or less than 350% of the federal poverty level 
who is enrolled in the program. 
"Qualified resident" also means 
a resident of the State whose family incurs unreimbursed expenses 
for prescription drugs that equal 5% or more of family income or 
whose total unreimbursed medical expenses equal 15% or more of 
family income. 
It changes the definition of "initial discounted 
price" and specifies the price at which a participating retail 
pharmacy 
shall 
sell 
covered 
drugs 
to 
a 
qualified resident. 
It directs the Department of Human Services 
to conduct ongoing quality assurance activities similar to those 
used in the MaineCare program. 
It changes dates for certain 
activities to be undertaken in connection with the Maine Rx Plus 
Program. 
It appropriates funds for unfunded positions for which 
a position count has already been established and for necessary 
operating costs in connection with the Maine Rx Plus Program. 
It 
also 
appropriates 
funds 
for 
the 
costs 
associated with 
the 
adoption of rules associated with the Maine Rx Plus Program by 
the Maine Board of Pharmacy.