State extends low-cost drug plan

AUGUSTA – Caught off guard this week by the expiration of discount agreements with drug companies, the state said Thursday it will extend until May 1 its commitment to participants in the Low Cost Drugs for the Elderly and Disabled program.

Any participant in the program, known as DEL, who paid full price for their medications this week should contact their pharmacy for reimbursement.

Goold Health Systems, the company that administers claims for all of the state’s drug programs, issued a statement Thursday afternoon saying that all prescriptions previously covered under the plan will be covered. Any that were rejected earlier in the week can be resubmitted for retroactive payment.

The Department of Human Services has extended until May 1 the deadline for companies to renegotiate rebate agreements. Within the last two days, the high-profile company Merck renewed its participation, along with Teva, a large producer of generic drugs.

The earlier deadline of March 15 passed with more than 100 companies that had been participating in the program not signed on. The state had extended that deadline for 30 days, but then when it expired on Monday, the still unrenewed agreements triggered a flurry of payment rejections at pharmacies across the state.

Pharmacist Kevin Clancy, owner of Island Pharmacy in Stonington, said he had received no notice of the impending loss of pharmacy discounts that enable him to serve the elderly poor in his community. “Nobody did,” he said. “It’s criminal. It’s outrageous.”

The two-week deadline extension is a good thing, Clancy said Thursday, “but what will happen after May 1?” He says it’s possible to use the time to switch patients from medications that aren’t covered to ones that are, but if most companies are going to come back on line with discounts, changes may be unnecessary.

Patients who are doing well on their medications shouldn’t switch if they don’t need to, Clancy noted. Making a change can be especially confusing to elderly people.

Newell Augur, spokesman for the Department of Human Services, said the current situation was an aftershock 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 again 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. About 100 companies, however, still have either specifically declined to participate, been unable to work out terms or simply failed to meet the deadline.

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

Pharmacists and their customers have been contacting their state representatives all week to protest the payment rejections on their medications and the lack of information accompanying them. Sen. Dennis Damon, D-Trenton, said a group of lawmakers has been working closely with DHS officials to help remedy the situation and will hold a press conference in Portland today.

Damon said there was no clear understanding of why companies that have balked at recommitting to Maine’s low-cost drug program should suddenly change their minds in the next two weeks, but pointed to Merck’s renewal as a good sign that others may follow suit.

DHS spokesman Newell Augur said the state would do everything it can over the next two weeks to convince other companies to reconsider their position. He would not speculate on why two key companies such as Merck and Teva suddenly signed on with DEL after months of stalemate.

Augur did acknowledge that the state “could have done a much better job of communicating” with pharmacists and DEL participants about the impending changes. When the May 1 deadline comes around, he said, “we’ll have that done right.”

For an updated list of participating drug companies and their products, visit the Goold Health Systems Web site at: www.ghsinc.com