DRUG VARIABLES

With the cost of prescription drugs rising another 15 percent last year, it is no wonder state government, which has considerably less health care money than it has demand, would try to reduce costs wherever possible. One of the several areas it chose was the amount it paid to pharmacies for MaineCare prescription drugs, which has caused the state’s largest drug-store chain, Rite Aid, to threaten to reduce service or close stores.

Legislators trying to figure out whether Rite Aid has a point, that Maine’s new rates would be unfairly low, will have trouble finding out where Maine rates fall. Currently, Maine pays 13 percent less than the average wholesale price for drugs, plus a $3.35 dispensing fee per prescription. That is less than what it paid in 1999, according to the National Pharmaceutical Council, but more than what it wants to pay in the future – the administration would drop the dispensing fee to $2. That would place its fee among the lowest in the country while its drug price would be just lower than average, making it in total, among the very lowest – bad, from the pharmacies’ view, but perhaps not the worst.

Unfortunately, the reimbursement variables don’t end just before the public’s patience for understanding them do. Unlike private plans, which generally pay a lower rate, Medicaid co-pays may be absent while patients get their prescriptions anyway. How much this affects the total is not known. And while some states limit the number of prescriptions an enrollee can have, Maine does not, another variable in the cost that does not show up neatly on a graph. The percentage of Medicaid business a pharmacy can expect is a third variable.

Maine is a poor state and it would be unreasonable for pharmacies to expect top rates here, but they shouldn’t expect the bottom either. Legislators need to get a better sense of where Maine stands vs. other states for these services and set a competitive rate. For that, they’ll need more information, and they will need it soon.