Drug rebates denied by state Companies stop DEL discounts

BANGOR – Buying prescription drugs got harder this week for thousands of Mainers, as participants in the state’s Low Cost Drugs for the Elderly and Disabled program are being denied coverage for essential medications. Pharmacists and consumers say they were caught unaware by changes the state has known about for months.

Rita Youngs, 83, went to fill her prescriptions Tuesday at Miller Drug in Bangor. The Brewer resident said she was shocked to find that Plavix – which she takes to prevent blood clots and the recurrence of a heart condition that left her on life support for two weeks – is no longer covered under the program known as DEL.

Instead of paying about $20 for a month’s supply, she said, the Plavix bill was $128. “They said the manufacturer [Bristol-Myers Squibb] was refusing to honor DEL, and that there would be no more discounts,” she told the Bangor Daily News. The pharmacy gave her a few days’ supply and told her to consult her doctor about a substitute medication.

Eva Oakes and her husband, Chesley, said their medications already cost more than $200 a month, with the DEL discount. A diabetic, Eva Oakes has been paying about $19 for Platel, a circulatory drug that now will cost $108. Chesley Oakes’ Plavix will make the same jump that Rita Young’s did. With a combined monthly income of about $1,100, Eva Oakes said, “We just can’t do it without [the manufacturers] signing the contract. I don’t know what we’ll do.”

Bill Miller, owner of Miller Drug, said the state’s electronic payment system began kicking back requests on Monday, indicating that many manufacturers no longer are participating in the state-funded DEL program, which serves about 36,000 Maine residents. The program, which taps about $20 million a year out of the General Fund, reimburses pharmacies about 80 percent of the average wholesale cost of medications, leaving consumers to pick up the remaining 20 percent.

“We’ve had all kinds of prescriptions being rejected all day long,” Miller said Tuesday. Miller said some customers have simply paid the full price for their drugs, if it’s low enough, but that many are unable to pay.

“I gave several people enough for a few days,” he said. He didn’t know what people would do after that. His efforts to get answers from the Department of Human Services and the Office of Health Care Policy and Finance had gone unanswered, he said.

The Maine Pharmacy Association confirmed that drugstores across the state were reporting the same problem without any explanation. Spokesman Bob Morrissette speculated that it could be “an incidental problem” of lost paperwork or bureaucratic miscommunication. “A week from now, this whole craziness may have disappeared,” he said.

But Newell Augur of the Department of Human Services, said the sudden rejections are anticipated aftershocks of the December 2002 demise of the Healthy Maine Prescriptions program. Augur said “the writing was on the wall” for DEL when a federal appeals court shot down the Medicaid waiver that enabled the Healthy Maine plan in 2001.

Healthy Maine had extended Medicaid-priced prescriptions to 113,000 Mainers living at or below 300 percent of the federal poverty rate.

Participants in DEL, which has been around since the 1970s, became part of that larger group. DEL benefited from its inclusion in the federally backed Healthy Maine program and its stronger, stabilized discount instead of the piecemeal deals arranged with individual manufacturers under the old DEL program.

When Healthy Maine was turned down in December, 77,000 Maine residents lost their drug discounts. The lower-income 36,000 people eligible for DEL became dependent on the state’s ability to renegotiate with individual manufacturers. Auger said many companies have been willing to honor pre-existing agreements with the state and others have worked out new deals. The incentive is the inclusion of their drug products on the “list of preferred medications” the state uses as its front-line resource for all its programs.

But lots of companies – about 100, according to list supplied by DHS – so far have either specifically declined to participate, been unable to work out terms or simply fallen behind a mid-March deadline for renegotiation. Many of the companies are relatively small, but the list includes well-known manufacturers and their products as well:

. Bristol-Myers Squibb

. Merck

. GlaxoSmithKline

. Novartis

. Pfizer

. Mead Johnson

Affected medications include those used to treat cardiac disease, diabetes, arthritis, lung disease, multiple sclerosis, osteoporosis and other chronic conditions.

Augur said the state will continue its efforts to sign companies on to the DEL program of supplemental rebates for poor, elder and disabled adults – in part, he said, because the recently passed 2004-05 state budget anticipates those savings.

Meanwhile, he said, consumers who find their medications are no longer affordable should ask their doctor or pharmacist about alternative drugs that may work as well.

But Miller, owner of the busy State Street drugstore, said more companies are not participating than are. The state, he said, is “just blowing smoke, hoping they won’t get a fight on their hands.”