October 22, 2024
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Discount drug program gets court approval Maine seen as pioneer among states

A pioneering program that offers prescription drugs at an average discount of 25 percent to some Mainers won a critical battle in the U.S. District Court for the District of Columbia on Monday.

In a summary judgment, Judge Ricardo Urbina rejected arguments from the Pharmaceutical Research and Manufacturers Association, known as PhRMA, that the federal government violated Medicaid rules by extending the program’s discounts to those not traditionally covered by Medicaid.

PhRMA had sued the federal government for granting Maine the waiver and Maine was granted intervenor status in the suit.

The decision means that the 110,000 Mainers already signed up for the program will be able to continue to get the drugs at a discounted cost at all 335 pharmacies in the state. Residents with incomes of up to 300 percent of the federal poverty level, about $25,800 for an individual in 2001, would qualify to buy drugs under the plan. Couples with incomes up to $34,800 are eligible. More than 115,000 additional Mainers may be eligible to sign up for the program.

“This is the victory we were looking for,” said Department of Human Services Commissioner Kevin Concannon. “To me I would say the green light is on in terms of what else we can do to help people get access to [cheaper drugs].”

DHS spokesman Newell Augur, who is also a lawyer, reviewed the 32-page opinion late Monday and called it “a major and complete victory for the state.”

Augur said the state expects PhRMA to appeal the decision.

A PhRMA spokesman said the trade association had yet to receive the summary judgment but issued a statement from Marjorie Powell, assistant general counsel for PhRMA.

“Maine’s program will harm the health of Medicaid patients by limiting their access to needed prescription drugs,” Powell’s statement read. “The Maine Medicaid waiver program requires physicians to get the state’s approval before writing prescriptions for drugs manufactured by companies that refuse to provide the equivalent of a Medicaid rebate for drugs dispensed to people who are not enrolled in, or indeed eligible for, Medicaid.”

PhRMA had won a similar case against Health and Human Services Commissioner Tommy Thompson for a Medicaid waiver granted to Vermont. But Maine’s program was different in that the state actually pays part of the bill just as it would with traditional Medicaid patients. That “state-only” money makes a difference, Urbina ruled.

Maine expects its share of the program to be about $20 million this year, Augur said.

Maine’s efforts to win drug-price discounts for the elderly and uninsured have pitted PhRMA and state officials and lawmakers in more than one battle. The trade association also worked hard to prevent passage of Maine’s broader prescription drug coverage plan, Maine Rx. Having failed to stop that in 2000, PhRMA’s legal challenge has worked its way up to the U.S. Supreme Court. The Supreme Court has asked for an opinion from the solicitor general before deciding whether to hear the case.

PhRMA argues that the Maine Rx program, which would require manufacturers to negotiate prices below the retail price or face profiteering laws, unconstitutionally regulates transactions outside Maine’s borders and conflicts with federal Medicaid law.

Concannon said the nation is watching the legal struggles and the latest decision will give some states confidence to move ahead. Just a few weeks ago, he said, he was in Hawaii to present details about Maine’s two programs to legislators there. Lawmakers on the Pacific islands have proposed two bills fashioned after Maine’s: One would be called the “Healthy Hawaii Prescription Program” and the other the “Hawaii Rx Program,” Concannon said.

Concannon, talking from a car phone, said that even though he hadn’t been able to read the decision yet, he was a happy man.

“For us it’s fabulous news,” he said.


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