An Act To Establish the Maine Prescription Drug Affordability Board
Maine Legislature, Session 129, LD 1499
Committee Amendment CA_A_S251 (Senate)
Amends: 5 MRSA §12004-G, 22 MRSA §8712, 5 MRSA §2041

COMMITTEE AMENDMENT "W' to S.P. 461, L.D. 1499, Bill, "An Act To 
Establish the Maine Prescription Drug Affordability Board" 
Amend the bill by striking out everything after the enacting clause and inserting the 
following: 
'Sec. 1. 5 MRSA c. 167 is enacted to read: 
CHAPTER167 
MAINE PRESCRIPTION DRUG AFFORDABILITY BOARD 
§2041. Maine Prescription Drug Affordability Board established 
1. 
Board established. 
The Maine Prescription Drug Affordability Board, as 
established in section 12004-G, subsection 14-I and referred to in this chapter as "the 
board," shall carry out the purposes of this chapter. 
2. Membership. The board has 5 members with expertise in health care economics 
or clinical medicine, who may not be affiliated with or represent the interests of a public 
payor, as that term is defined in section 2042, and who are appointed as follows: 
A. Two members by the President of the Senate. The President of the Senate shall 
also appoint one alternate board member who will participate in deliberations of the 
board in the event a member appointed by the President of the Senate elects to be 
recused as provided in subsection 7, paragraph B; 
B. Two members by the Speaker of the House of Representatives. The Speaker of 
the House of Representatives shall also appoint one alternate board member who will 
participate in deliberations of the board in the event a member appointed by the 
Speaker of the House of Representatives elects to be recused as provided in 
subsection 7, paragraph B; and 
C. One member by the Governor. The Governor shall also appoint one alternate 
board member who will participate in deliberations of the board in the event the 
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<l 
member appointed by the Governor elects to be recused as provided in subsection 7, 
paragraph B. 
3. Terms. Members are appointed to 5-year terms. Of the initial appointees, the 
member appointed by the Governor serves an initial term of 5 years, one member 
appointed by the President of the Senate and one member appointed by the Speaker of the 
House of Representatives serve an initial term of 4 years and one member appointed by 
the President of the Senate and one member appointed by the Speaker of the House of 
Representatives serve an initial term of 3 years. 
4. Quorum. A majority of board members constitutes a quorum. 
5. Chair. The Governor shall name the chair. 
6. Meetings. Beginning no later than March 1, 2020, the board shall meet in public 
session at least every 12 weeks to review prescription drug information and to make 
recommendations pursuant to section 2042. Meetings may be cancelled or postponed at 
the discretion of the chair. 
A. Each public meeting must be announced 2 weeks in advance, and materials for 
the meeting must be made public at least one week in advance. 
B. Each public meeting must provide opportunity for comment from the public in 
attendance at the meeting, and the board shall provide the opportunity for the public 
to submit written comments on pending decisions. 
C. 
The board may allow expert testimony at public meetings and any meeting 
conducted in executive session as permitted by paragraph D. 
D. Notwithstanding the requirements of Title 1. section 405. the board may meet in 
executive session. except that any decision of the board must be made in public. 
7. Conflicts of interest. The following provisions govern any conflict of interest for 
a member of the board. a member of the advisory council established pursuant to 
subsection 10 or any staff member or contractor of the board. 
A. When appointing a member of the board or the advisory council established 
pursuant to subsection 10, the appointing authority shall consider any conflict of 
interest disclosed by the prospective member. A member shall elect to be recused 
from any board activity in the case in which the member or an immediate family 
member of the member has a conflict of interest. For the purposes of this paragraph, 
"conflict of interest" means an association, including a financial or personal 
association, that has the potential to bias or have the appearance of biasing an 
individual's decisions in matters related to the board or the conduct of the board's 
activities. 
B. A board member or staff or contractor of the board with a conflict of interest shall 
elect to be recused. For purposes of this paragraph. "conflict of interest" means any 
instance in which a member of the board or an immediate family member of the 
member has received or could receive either of the following: 
(1) A direct financial benefit of any amount deriving from the results or findings 
of a study or determination by or for the board; or 
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(2) A financial benefit from individuals or companies that own or manufacture 
prescription drugs, services or items to be studied by the board that in the 
aggregate exceeds $5,000 per year. For purposes of this subparagraph, "financial 
benefit" includes honoraria, fees, stock or other financial benefit and the current 
value of the member's or immediate family member's already existing stock 
holdings, in addition to any direct financial benefit deriving from the results or 
findings conducted under this section. 
C. A conflict of interest must be disclosed in the following manner: 
(1) By the board in the employment of board senior staff; 
(2) 
By the Governor, President of the Senate or Speaker of the House of 
Representatives when appointing members to the board and advisory council 
established pursuant to subsection 1 O; 
(3) By the board, describing any recusals as part of any final decision relating to 
a prescription drug; and 
(4) By the 5th day after a conflict is identified or, if a public meeting of the 
board will occur within that 5-day period, in advance of the public meeting. 
D. Conflicts of interest must be publicly posted on the website of the board. The 
information disclosed must include the type, nature and magnitude of the interests of 
the individual involved, except to the extent that the individual elects to be recused 
from participation in any activity with respect to which the potential conflict exists. 
E. The board, the advisory council established pursuant to subsection 10, a member 
of the board or staff or a contractor of the board may not accept gifts, bequests or 
donations of services or property that suggest a conflict of interest or have the 
appearance of creating bias in the work of the board or advisory council. 
F. A member of the advisory council established pursuant to subsection 10 who 
accepts a gift, bequest or donation of services or property that suggests a conflict of 
interest or has the appearance of creating bias in the work of the advisory council 
shall disclose the gift, bequest or donation publicly. 
8. Staff. The board may employ an executive director, whose salary, to the extent 
feasible, must comp01t with state personnel rules and requirements. 
9. Compensation. A member of the board and a member of the advisory council 
appointed pursuant to subsection 10, paragraph L are entitled to legislative per diem and 
reimbursement for expenses as provided in section 12004-G, subsection 14-1. 
10. Advisory council. A 12-member advisory council is established to advise the 
board on establishing annual spending targets pursuant to section 2042, subsection 1 and 
determining methods for meeting those spending targets pursuant to section 2042, 
subsection 3. The advisory council consists of: 
A. The Governor or the governor's designee; 
B. 
The Commissioner of Administrative and Financial Services or the 
commissioner's designee; 
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2.~) \ 
C. The Commissioner of Corrections or the commissioner's designee; 
D. 
The Commissioner of Health and Human Services or the commissioner's 
designee; 
E. The Attorney General or the Attorney General's designee; 
F. The Executive Director of Employee Health and Benefits, within the Department 
of Administrative and Financial Services, Bureau of Human Resources, or the 
executive director's designee; 
G. A representative from the Maine State Employees Association, appointed by the 
Governor, based on a nomination by the association; 
H. 
A representative from the Maine Education Association, appointed by the 
Governor, based on a nomination by the association; 
I. 
A representative from the Maine Municipal Association, appointed by the 
Governor, based on a nomination by the association; 
J. 
A representative from the University of Maine System, appointed by the 
Governor, based on a nomination by the system; 
K. A representative from the Maine Community College System, appointed by the 
Governor, based on a nomination by the system; and 
L. A representative of consumer interests, appointed by the Governor, who serves a 
3-year term. 
11. Funds and grants. The board may apply for and receive funds, grants or 
contracts from public and private sources. 
12. Assessment. The board may recommend that a public payor, as defined in 
section 2042, subsection 1, pay an annual assessment to support the administrative costs 
of the board. 
§2042. Powers and duties of the board 
1. Prescription drug spending targets. The board has the following powers and 
duties. For the purposes of this section, the term "public payor" means any division of 
state, county or municipal government that administers a health plan for employees of 
that division' of state, county or municipal government or an association of state, county 
or municipal employers that administers a health plan for its employees, except for the 
MaineCare program. The board shall: 
A. 
Beginning for the year 2021 and in consultation with the advisory council 
established under section 2041, subsection 10, determine annual spending targets for 
prescription drugs purchased by public payors based upon a 10-year rolling average 
of the medical care services component of the United States Department of Labor, 
Bureau of Labor Statistics Consumer Price Index medical care services index plus a 
reasonable percentage for inflation and minus a spending target determined by the 
board for pharmacy savings; 
B. 
Determine spending targets on specific prescription drugs that may cause 
affordability challenges to enrollees in a public payor health plan; and 
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LS'\) 
C. 
Determine which public payors are likely to exceed the spending targets 
determined under paragraph A. 
2. Prescription drug spending data. The board may consider the following data to 
accomplish its duties under this section: 
A. 
A public payor's prescription drug spending data, which the 3rd-party 
administrator or insurer for the public payor's health plan shall provide to the board 
on behalf of the public payor upon request notwithstanding any provision of law to 
the contrary, including: 
(1) Expenditures and utilization data for prescription drugs for each plan offered 
by a public payor: 
(2) The formulary for each plan offered by a public payor and prescription drugs 
common to each formulary: 
(3) Pharmacy benefit management services and other administrative expenses of 
the prescription drug benefit for each plan offered by a public payor; and 
(4) Enrollee cost sharing for each plan offered by a public payor; and 
B. Data compiled by the Maine Health Data Organization under Title 22, chapter 
1683. 
Prescription drug spending data provided to the board under this subsection is 
confidential to the same extent it is confidential while in the custody of the entity that 
provided the data to the board. 
3. Recommendations. Based upon the prescription drug spending data received 
under subsection 2, the board, in consultation with a representative of each public payor 
identified under subsection 1, paragraph A, shall determine methods for the public payor 
to meet the spending targets established under subsection 1. The board shall determine 
whether the following methods reduce costs to individuals purchasing prescription drugs 
through a public payor and allow public payors to meet the spending targets established 
under subsection 1: 
A. Negotiating specific rebate amounts on the prescription drugs that contribute most 
to spending that exceeds the spending targets; 
B. Changing a formulary when sufficient rebates cannot be secured under paragraph 
A' 
= 
C. 
Changing a formulary with respect to all of the prescription drugs of a 
manufacturer within a formulary when sufficient rebates cannot be secured under 
paragraph A; 
D. Establishing a common prescription drug formulary for all public payors; 
E. 
Prohibiting health insurance carriers in the State from offering on their 
formularies a prescription drug or any of the prescription drugs manufactured by a 
particular manufacturer when the methods described in paragraph B or C are 
implemented; 
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' 
/ 
F. Purchasing prescription drugs in bulk or through a single purchasing agreement 
for use among public payors; 
G. Collaborating with other states and state prescription drug purchasing consortia to 
purchase prescription drugs in bulk or to jointly negotiate rebates; 
H. Allowing health insurance carriers providing coverage to small businesses and 
individuals in the State to participate in the public payor prescription drug benefit for 
a fee; 
I. Procuring common expert services for public payors, including but not limited to 
pharmacy benefit management services and actuarial services; and 
J. Any other method the board may determine. 
4. Report. The board shall report its recommendations, including prescription drug 
spending targets, and the progress of implementing those recommendations to the joint 
standing committee of the Legislature having jurisdiction over health coverage and 
insurance matters no later than October 1, 2020 and on January 30th annually thereafter. 
The joint standing committee may report out legislation based upon the report. 
Sec. 2. 5 MRSA §12004-G, sub-§14-1 is enacted to read: 
14-1. 
Health care 
Maine Prescription 
Drug Affordability 
Board and advisory 
council 
Legislative Per 
Diem and Expenses 
Sec. 3. 22 MRSA §8712, sub-§6 is enacted to read: 
MRSA §2041 
6. 
Data shared with Maine Prescription Drug Affordability Board. 
The 
organization may share data collected under this chapter with the Maine Prescription 
Drug Affordability Board, established under Title 5, section 12004-G, subsection 14-I, as 
long as any data shared pursuant to this subsection is not further disseminated.' 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively. 
SUMMARY 
This amendment replaces the bill. 
The amendment, as in the bill, establishes the Maine Prescription Drug Affordability 
Board but removes the provisions that allow rate setting by the board and require the 
board to determine excess prescription drug costs based upon certain thresholds for 
prescription drug prices and price increases. 
The amendment instead provides that the board determines prescription drug 
spending targets for public entities, including for specific prescription drugs, based upon 
a 10-year rolling average of the medical care services component of the United States 
Department of Labor, Bureau of Labor Statistics Consumer Price Index medical care 
services index plus a reasonable percentage for inflation and minus a spending target 
COMMITTEE AMENDMENT 
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determined by the board for pharmacy savings and in consideration of information 
received about the public entity's prescription drug spending and information collected 
by the Maine Health Data Organization. The board makes recommendations on 
prescription drug spending targets, including spending targets for specific prescription 
drugs, with input from representatives of those public entities. The recommendations may 
include establishing a common prescription drug formulary among public payors, 
purchasing prescription drugs in bulk or through a single purchasing agreement, 
collaborating with other states and state prescription drug purchasing consortia to 
purchase prescription drugs in bulk or to jointly negotiate rebates, allowing health 
insurance carriers providing coverage to small businesses in the State to participate in a 
public payor prescription drug benefit for a fee, procuring common pharmacy benefit 
management services and actuarial services, negotiating specific rebates and removing 
drugs for which a manufacturer does not negotiate a sufficient rebate from a formulary 
and other methods determined by the board. The board is required to report its 
prescription drug spending targets and the methods recommended to meet those targets to 
the Legislature annually. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Revised: 06/05/19 :ttP'aC':.. 
LD 1499 
LR 973(02) 
An Act To Establish the Maine Prescription Drug Affordability Board 
Fiscal Detail and Notes 
Fiscal Note for Bill as Amended by Committee Amendment" fl' .. 
Committee: Health Coverage, Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - General Fund 
Any additional costs to the departments whose commissioners or their designees are required to serve on the Advisory 
Council to the Maine Prescription Drug Affordability Board are assumed to be minor and can be absorbed within 
existing budgeted resources. Additional costs to the State Employee Health Plan and to the Maine Health Data 
Organization to provide data and consult with the board are expected to be minor and can be absorbed within existing 
budgeted resources. 
LR0973(02) - Fiscal Note - Page 1 of 1