An Act To Reimburse Pharmacies under the MaineCare Program Based on Wholesale Acquisition Costs
Maine Legislature, Session 124, LD 1615
Committee: Health and Human Services
Sponsors: LEWIN, RA YE, CURTIS, EVES, JOHNSON, SYKES, COURTNEY, SHERMAN
Amends: 22 MRSA §3174-P

SECOND REGULARSESSION-2010· 
Legislative Document 
No. 1615 
H.P.1143 
House of Representatives, December 23, 2009· 
An Act To Reimburse Pharmacies under the MaineCare Program 
Based on Wholesale Acquisition Costs 
(EMERGENCY) 
Approved for introductionby a majority of the Legislative Coul1cil pursuant to Joint Rule 
203. 
. 
Received by the Clerk of the House ori December 21,2009. Referred to the Committee on 
Health and Human Services pursuant toJoint Rule 308.2 and ordered printed p~lrsuant to Joint 
Rule 401. 
Presented by Representative LEWIN of Eliot. 
Cosponsored by Senator RA YE of Washington and 
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117· 7Ili4~£iM4{' 
MILLICENT M. MacFARLAND 
Clerk 
Representatives: CURTIS of Madison, EVES of North Berwick, JOHNSON of Greenville, 
Speaker PINGREE 6fNorth 'Haven; STRANG BURGESS of Cumberland, SYKES of 
Harrison, Senators: COURTNEY of York, SHERMAN of Aroostook. 
Prinlr:u lIn n:cycl~d pap~r 
Emergency preamble.' Whereas, acts and' resolves of the Legislature do not 
become effective until 90 days after adjournment unless enacted ,as emergencies; and 
Whereas, the adequate reimbursement of pharmacies for dispensing prescription 
drugs under the MaineCare program is critical to the financial stability of the pharmacies; 
and 
Whereas, as a result of the settlement of litigation in the First DataBank and 
MediSpan case in which First DataBank and' MediSpan were ordered to reduce the 
average wholesale price used in· determining pharmacy reimbursement beginning 
Septell)ber26, 2009 in the federal Medicaid program, pharmacy reimbursement will be 
· 10 
suddenly reduced, with the possible result of destabilizing the pharmacies orMaine and 
patient access to pharmacy services; and 
Whereas, in the judgment of the Legislature, these facts create an emergency with in 
the meaning of the Constitution of Maine and require the following legislation as 
immediately necessary for the preE ;rvation of the public peace, health and safety; now; 
therefore, 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 22 MRSA §3174-PP is enacted to read: 
§3174-PP. MaineCare pharmacy reimbursement 
1. 
Definition. 
For the purposes of this section, unless the context otherwise 
indicates, "wholesale acquisition cost" means the cost of a covered brand name or generic 
prescription drug based on the size onhe package from.which the drug is dispensed as 
. reported by-the prescription drug pricing service used by the department. 
2. Reimbursement rate. The department shaH reimburse pharmacies for dispensing 
brand name and generic prescription drugs covered by the MaineCare program based on a 
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formula that uses the wholesale acquisition cost and that includes a dispensing fee. The 
formula and pharmacy reimbursement must be calculated using the wholesale acquisition 
cost plus 6.7% and a dispensing fee of $3.35 per prescription. 
3. Application; retroactivity. The formula and pharmacy reimbursement required 
under subsection 2 applies retroactively to reimbursements to pharmacies to cover brand 
name and generic prescription drugs dispensed under the MaineCare program beginning 
September 26, 2009. 
. 
4. Rulemaking. The department shall adopt rules to implement this section no later 
toan July 1, 2010. Rules adopted pursuant to this subsection are routine technical rules as 
defined in Title 5, chapter 375, subchapter 2-A. 
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Emergency clause. 
In view of the emergency cited in the preamble, this 
legislation takes effect when approved. 
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SUMMARY 
This bill requires the Department of Health and Human Services to reimburse 
pharmacies [oj- dispensing covered brand name and generic drugs under the MaineCare 
program based on a formula that includes calculated wholesale acquisition cost plus 6.7% 
and a dispensing fee of $3.35 per prescription and allows the department to adopt routine 
technical rules. The formula applies to drugs dispensed under the MaineCare program on 
or after September 26, 2009.