An Act To Reimburse Phannacies under the MaineCare Program Based on Wholesale Acquisition Costs
Maine Legislature, Session 125, LD 0346
Committee Amendment CA_A_H563 (House)
Committee: Health and Human Services
Amends: 22 MRSA §3173-C

COMMITTEE AMENDMENT "(1,, to H.P. 272, L.D. 346, Bill, "An Act To 
Reimburse Phannacies under the MaineCare Program Based on Wholesale Acquisition 
Costs" 
Amend the bill by striking out the title and substituting the following: 
'An Act Regarding Pharmacy Reimbursement in MaineCare' 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 22 MRSA §3173-C, sub-§2, as amended by PL 2007, c. 240, Pt. GGG, 
§ 1, is further amended to read: 
2. 
Prescription drug services. 
Except as provided in this subsection and 
subsections 3 and 4, a payt:nent of pharmacy shall charge a MaineCare member $3.00 fof 
each drug is to be collected from the MaineCare member for each drug prescription that 
is an approved MaineCare service. The department shall adopt and follow procedures to 
ensure compliance with the requirements of 42 United States Code, Section 13960-1. A 
pharmacy that has followed the procedures adopted- by the department to ensure 
compliance with the requirements of 42 United States Code, Section 13960-1 may refuse 
to dispense the drug if the copayment is not paid. Copayments must be capped at $30 per 
month per member. If a member is prescribed a drug in a quantity specifically intended 
by the provider or pharmacist, for the recipient's health and welfare, to last less than one 
month, only one payment for that drug for that month is required. 
Sec. 2. 22 MRSA §3173-C, sub-§8 is enacted to read: 
8. Notification. The department shall notify each MaineCare member who is subject 
to the copayment requirement in subsection 2 of the copayment requirements, any 
exemptions and limitations prior to coding the member's information for required 
copayments and shall notify the member again during annual recertification of eligibility. 
Sec. 3. Review of cost of dispensing a prescription drug; report. The 
Department of Health and Human Services shall review the cost of dispensing a 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT" A" to H.P. 272, L.D. 346 
prescription drug under the MaineCare program. By January 15, 2012, the department 
shall provide a report with recommendations to the Joint Standing Committee on Health 
and Human Services. In performing the review the department shall: 
1. Provide opportunity for input to pharmacists and pharmacies licensed in the State 
and their representatives; 
2. 
Consider changing copayments and dispensing fees under the MaineCare 
program; 
3. Consider all recent federal studies of formulae for pharmacy reimbursement and 
information available from the United States Department of Health and Human Services, 
Centers for Medicare and Medicaid Services; and 
4. Review current and pending pharmacy reimbursement formulae under federal 
Medicaid law. 
Sec. 4. Appropriations and allocations. The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY DHS) 
Bureau of Medical Services 0129 
Initiative: Appropriates and allocates funds on a one-time basis for the eligibility and 
payment system upgrades and other requirements needed to implement mandatory 
prescription drug copayments. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
2011-12 
$27,500 
$27,500 
2011-12 
$27,500 
$27,500 
2012-13 
$0 
$0 
2012-13 
$0 
$0 
Sec. 5. Effective date. Those sections of this Act that amend the Maine Revised 
Statutes, Title 22, section 3173-C, subsection 2 and enact Title 22, section 3173-C, 
subsection 8 take effect upon amendment and federal approval of the Medicaid state plan 
but no earlier than October 1, 20 II.' 
SUMMARY 
This amendment is the majority report of the committee. This amendment replaces 
the bill. The amendment: 
1. 
Authorizes pharmacies to charge MaineCare members copayments for 
prescription drugs dispensed and allows pharmacies to refuse to dispense if copayments 
COMMITTEE AMENDMENT 
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()~s. 
COMMITTEE AMENDMENT "A" to H.P. 272, L.D. 346 
are not paid as long as certain procedures are in place and are followed by the Department 
of Health and Human Services and the pharmacies; 
2. 
Adds a provision requiring notice to MaineCare members of copayment 
requirements; 
3. Provides an effective date for the statutory changes upon amendment and federal 
approval of the Medicaid state plan but no earlier than October 1, 2011; 
4. Directs the Department of Health and Human Services to review the cost of 
dispensing a prescription drug under the MaineCare program, to review other information 
available on pharmacy reimbursement and to report by January 15, 2012 to the Joint 
Standing Committee on Health and Human Services with recommendations regarding the 
dispensing fee; and 
5. Adds an appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 06/03/11 frac. 
LD346 
LR 978(02) 
An Act To Reimburse Pharmacies under the MaineCare Program Based on Wholesale Acquisition 
Costs 
Fiscal Note for Bill as Amended by Committee Amendment '/}' 
Committee: Health and Human Services 
Net Cost (Savings) 
General Fund 
Appropriations/Allocations 
General Fund 
Federal Expenditures Fund 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
Potential current biennium savings - General Fund 
FY2011-12 
$27,500 
$27,500 
$27,500 
FY 2012-13 
$0 
$0 
$0 
Projections 
FY 2013-14 
$0 
$0 
$0 
Projections 
FY 2014-15 
$0 
$0 
$0 
Provides a one-time General Fund appropriation and Federal Expenditures Fund allocation to the Office of MaineCare 
Service in the Department of Health and Human Services for eligibility and payment system upgrades and to meet 
other requirements needed to implement a mandatory MaineCare prescription drug co-payment system. Also assumes 
that implementation of a mandatory prescription drug co-payment system that will result in prescription drugs not 
being dispensed because of failure to pay co-payments will result in a decrease in MaineCare prescription drug 
utilization and spending that cannot be quantified at this time. 
LR0978(02) - Fiscal Note - Page 1 of 1