Cheaper prescription drugs

A 25 percent discount for prescription drugs for 225,000 Mainers without insurance is a significant step forward in this state’s attempt to help all residents obtain affordable health care. Human Services Commissioner Kevin Concannon and his staff deserve credit for putting together the federal Medicaid waiver needed to make it happen.

Similar to a program in Vermont, the program provides discounted prescription drugs to Maine residents with incomes up to 300 percent of the federal poverty level. A single person could be earning $25,000 a year, a family considerably more. The waiver provides for a dramatic expansion of the Maine Medicaid current prescription-drug benefit, bringing in many more working families that do not have this health benefit through employment. The waiver will cover with a similar benefit about 70 percent of those who would be eligible under Maine’s planned RX program, which the pharmaceutical lobby (PhRMA) has taken to court to permanently stop.

Commissioner Concannon notes that the waiver has “the official seal of approval from the United States Government,” but the pharmaceutical lobby probably will sue Maine over this program as well, just as it did in Vermont. Unlike the Maine RX program, however, a judge in the Vermont case recently denied PhRMA’s request to stop the program until a final ruling is made.

A waiver like Vermont or Maine’s from the federal Health Care Finance Administration is illegal, PhRMA charges, because it affects more than just poor people and it requires participants to pay a substantial share (the remaining 75 percent) of the drug cost. The underlying intent of Medicaid is to cover health care costs to people who cannot afford it, so, for instance, some people with specific illnesses receive Medicaid help even if they are not poor. And Medicaid has covered more than the poor for many years. For instance, MinnesotaCare, begun in 1995, provides a broad range of medical coverage to residents there with incomes up to 275 percent of the federal poverty limit.

As long as prescription drugs continue to be the fastest rising cost in medical care and the price of these drugs is far higher in the United States than anywhere else, states are going to find ways around the cost of this huge burden. PhRMA, of course, will go right on suing anyone who threatens its record-breaking profits, and for a while might even succeed in some places. But neither state nor the federal government will sit by while millions of people are denied needed drugs because of their high price. And simply expanding coverage does little to bring the prices under control. A negotiation – as is done in other nations, with HMOs, and with some federal programs including Medicaid – must take place to balance PhRMA members’ demand for profits beyond their research funding with the budgets of people who need the drugs.

Absent negotiation, look for many more actions like the Medicaid waiver, where states act quietly to expand benefits and, eventually, win.