An Act to Direct the Maine Prescription Drug Affordability Board
Maine Legislature, Session 132, LD 0697
Sponsors: RENY, MATHIESON
Amends: 5 MRSA §2041, 5 MRSA §2042

Legislative Document
No. 697
S.P. 314
In Senate, February 25, 2025
An Act to Direct the Maine Prescription Drug Affordability Board 
to Assess Strategies to Reduce Prescription Drug Costs and to Take 
Steps to Implement Reference-based Pricing
Received by the Secretary of the Senate on February 20, 2025.  Referred to the Committee 
on Health Coverage, Insurance and Financial Services pursuant to Joint Rule 308.2 and ordered 
printed.
DAREK M. GRANT
Secretary of the Senate
Presented by Senator RENY of Lincoln.
Cosponsored by Representative MATHIESON of Kittery and
Senators: BAILEY of York, INGWERSEN of York, RAFFERTY of York, TEPLER of 
Sagadahoc, Representative: MASTRACCIO of Sanford.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  5 MRSA §2041, sub-§2, as repealed and replaced by PL 2021, c. 293, Pt. 
A, §5, is amended to read:
2.  Membership.    The board has 5 consists of 6 members with expertise in health 
policy, health care data, health care economics or clinical medicine, who may not be 
affiliated with or represent the interests of a pharmaceutical manufacturer or a public payor, 
as that term is defined in section 2042, and who are appointed as follows:
A.  Two members appointed 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 appointed 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 appointed by the Governor. The Governor shall also appoint one 
alternate board member who will participate in deliberations of the board in the event 
the member appointed by the Governor elects to be recused as provided in subsection 
7, paragraph B.; and
D.  The executive director of the Maine Health Data Organization established by Title 
22, section 8703, or the executive director's designee, who serves as an ex officio, 
nonvoting member.
Sec. 2.  5 MRSA §2041, sub-§9, as repealed and replaced by PL 2021, c. 293, Pt. 
A, §5, is amended to read:
9.  Compensation. A Except for the member under subsection 2, paragraph D, 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‑I.
Sec. 3.  5 MRSA §2041, sub-§10, as repealed and replaced by PL 2021, c. 293, Pt. 
A, §5, is amended to read:
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;
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 Service 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.
Sec. 4.  5 MRSA §2041, sub-§12, as repealed and replaced by PL 2021, c. 293, Pt. 
A, §5, is repealed.
Sec. 5.  5 MRSA §2042, as repealed and replaced by PL 2021, c. 293, Pt. A, §5, is 
amended to read:
§2042.  Powers and duties of the board
The board has the following powers and duties.
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
C.  Determine which public payors are likely to exceed the spending targets determined 
under paragraph A.
1-A.  Strategies to reduce costs of prescription drugs.  The board shall:
A.  Review prescription drug spending and utilization data to identify causes of high 
spending or rising spending affecting public payors and private payors and impacting 
consumers;
B.  Solicit public input to identify cost-related barriers to accessing prescription drugs; 
and
C.  Assess strategies to reduce the cost of prescription drugs and reduce the rate of 
growth in prescription drug spending and to reduce cost barriers for consumers. The 
review of strategies must include consideration of the strategies' likely impact on 
consumers and overall health care costs and the feasibility of implementing such 
strategies. At a minimum, the board shall assess the following strategies:
(1)  Empowering the board to assess the affordability of drugs and to establish 
upper payment limits;
(2)  Implementing reference-based pricing, including reviewing potential savings 
for the state employee group health plan under Title 5, section 285 by 
implementing reference-based pricing for the first 10 drugs negotiated under the 
Medicare drug price negotiation program established in United States Public Law 
117-169 (August 16, 2022);
(3)  Recommending annual spending targets for prescription drugs for public 
payors and implementing strategies for the purchase of prescription drugs by public 
payors in order to meet those annual spending targets, including group purchasing 
and formulary alignment.  For the purposes of this subsection, 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;
(4)  Recommending annual spending targets for prescription drugs that could be 
applied to one or more segments of the state-regulated commercial insurance 
market and implementing strategies to meet those annual spending targets;
(5)  Implementing transparency requirements and regulation of supply chain 
entities, including, but not limited to, pharmacy benefits managers, including 
regarding the role of discounts and rebates in prescription drug costs;
(6)  Implementing strategies to reduce out-of-pocket costs for prescription drugs 
through the regulation of insurance and the rate review process of the Department 
of Professional and Financial Regulation, Bureau of Insurance;
(7)  Developing opportunities for engagement with providers and other health care 
professionals to disseminate information about prescription drug costs and pricing; 
and
(8)  Aligning the payment for prescription drugs with actual drug acquisition costs.
1-B.  Other states' experiences.  To accomplish the duties under subsection 1-A, the 
board shall consider and review the experiences of other states, including, but not limited 
to, the role of prescription drug affordability boards established in other states that are 
authorized to assess affordability of prescription drugs and to establish upper payment 
limits or reference-based pricing requirements and their regulation of pharmacy benefits 
managers.
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 Prescription drug spending data, which the not 
available through the Maine Health Data Organization. The board may request data 
under this paragraph from 3rd‑party administrator administrators or insurer for the 
public payor's health plan shall provide to the board on behalf of the public payor upon 
request insurers 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 benefits manager 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 other 
available information regarding costs to consumers, including premiums and out-
of-pocket costs; and
B.  Data compiled by the Maine Health Data Organization under Title 22, chapter 1683.
Prescription drug spending data provided to the board and its staff 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;
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 any recommendations, including prescription 
drug spending targets, and the progress of implementing those recommendations regarding 
strategies to reduce the cost of prescription drugs, other states' experiences and prescription 
drug spending data 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.
5.  Rulemaking.  The board may adopt rules to carry out the purposes of this chapter. 
Rules adopted pursuant to this subsection are routine technical rules as defined by chapter 
375, subchapter 2-A.
Sec. 6.  Affordability program.  The Maine Prescription Drug Affordability Board 
established under the Maine Revised Statutes, Title 5, section 2041, referred to in this 
section as "the board," in consultation with its advisory council established under Title 5, 
section 2041, subsection 10 and any technical committees the board may establish, shall 
develop a program to reduce the impact of prescription drug costs on the State's health care 
system, stem the rate of growth in prescription drug spending and reduce cost barriers for 
consumers. The program must be based on the prescription drug spending data received 
under Title 5, section 2042, subsection 2 and the assessment conducted under Title 5, 
section 2042, subsections 1-A and 1-B, include recommended implementation and 
enforcement strategies and identify necessary funding and regulatory and legislative 
authority.
1.  The board shall adopt and submit a preliminary plan for a prescription drug 
affordability program in its annual report due by January 30, 2026 pursuant to the Maine 
Revised Statutes, Title 5, section 2042, subsection 4 to the Joint Standing Committee on 
Health Coverage, Insurance and Financial Services.  The preliminary plan must include 
any proposals for legislative action needed to implement the program.  The joint standing 
committee may report out legislation based upon the report to the 133rd Legislature in 
2027.
2.  The board shall adopt and submit its final plan for a prescription drug affordability 
program in a report to the joint standing committee of the Legislature having jurisdiction 
over health coverage, insurance and financial services matters by October 1, 2027.  The 
final plan must include any proposals for legislative action needed to implement the 
program.  The joint standing committee may report out legislation based upon the report to 
the Second Regular Session of the 133rd Legislature.
SUMMARY
This bill makes the following changes to the laws governing the Maine Prescription 
Drug Affordability Board.
1. It adds to the board the executive director of the Maine Health Data Organization, 
or the executive director's designee, as an ex officio, nonvoting member.
2. It removes the authority of the board to recommend that public payors pay an annual 
assessment to support the administration of the board.
3. It changes the scope of the duties of the board from determining prescription drug 
spending targets to focusing on an assessment of strategies to reduce prescription drug 
costs, reduce the rate of growth in prescription drug spending and reduce cost barriers for 
consumers.
4. It requires the board to review how states with authority to establish upper payment 
limits have implemented that authority and their regulation of pharmacy benefits managers, 
to recommend whether the board should have comparable authority and to assess 
implementing reference-based pricing for the first 10 prescription drugs for which the 
Medicare program has negotiated maximum fair prices through the Medicare drug price 
negotiation program.
5. It requires the board to recommend annual spending targets for prescription drugs 
for public payors and implementing complementary purchasing strategies; annual spending 
targets and strategies for the commercial insurance market; transparency requirements and 
supply chain regulation; strategies to reduce out-of-pocket costs through insurance 
regulation; and aligning prescription drug payment with acquisition costs.
The bill also directs the board to recommend a program to reduce the impact of 
prescription drug costs on the State's health care system, stem the rate of growth in 
prescription drug spending and reduce cost barriers for consumers based on data the board 
has collected.  The board is directed to submit in reports to the joint standing committee of 
the Legislature having jurisdiction over health coverage, insurance and financial services 
matters a preliminary plan to implement the program by January 30, 2026 and a final plan 
by October 1, 2027.  The joint standing committee is authorized to report out legislation 
based on the reports.