PORTLAND (AP) – Additional drug discounts may be in the offing under the Maine Rx Plus program for Mainers who lack prescription drug coverage.

State officials say they are talking with 20 drug companies about offering 5 to 10 percent discounts on top of savings already offered by pharmacies that range from 15 percent for branded products to up to 60 percent for generics.

An estimated 275,000 Mainers, or more than a fifth of the state’s population, are eligible for the nearly year-old program, with 99,000 enrolled thus far.

If all goes as planned, the state hopes to negotiate additional discounts by January.

Negotiations with drug companies are seen as a “carrot” approach, as opposed to the “stick” of “prior authorization” that remains available under the Maine Rx Plus law but has not been used.

Companies that refuse to discount could be forced to get state approval before prescribing certain drugs. In the years since the drug discount program was created, prior authorization has become common in MaineCare, the government program that insures 260,000 poor and disabled Mainers.

By this spring, as the state planned to negotiate discounts for Maine Rx Plus for the same drugs preferred in MaineCare, some of those companies that provided extra rebates in MaineCare showed interest, said Jude Walsh, who oversees pharmacy affairs for the Governor’s Office of Health Policy and Finance.

“This is voluntary,” Walsh said. “We’re working with the companies that seem to want to work with us anyway.”

Drug companies seeking to increase market share are aware that physicians tend to prescribe the same brands of drugs across their patient base, Walsh said, and may lean toward products known as drugs of choice in various programs.

Despite the state’s announcement that it would not use prior authorization without federal approval, the drug industry’s largest trade group, Pharmaceutical Research and Manufacturers of America, says it will not rest easy.

PhRMA argued on Sept. 9 in federal court in Providence, R.I. – judges in Maine had recused themselves from the case – that the state must go to the federal Centers for Medicare and Medicaid for a decision on the program, even if it has no plans to use prior authorization now.

PhRMA halted for three years an earlier version of Maine Rx Plus that focused on prior authorization as a bargaining tool. The U.S. Supreme Court lifted an injunction on the program, saying PhRMA did not show why it should be blocked, and sent it back to federal district court for review.

The state, meanwhile, added an income cap and asked pharmacists to provide the initial discounts. The retooled program began in mid-January.

Arn Pearson, executive director of the non-profit Maine Citizen Leadership Fund, which helped to defend the original Maine Rx in court, didn’t fault the state for shelving prior authorization.

“As long as they haven’t conceded their ability to use prior authorization under Maine Rx and they are negotiating discounts through different means, we’re probably OK,” Pearson said.

Pearson said prior authorization could be used if the marketplace changes.

Current discounts are made possible by the participation of more than 100 pharmacies. Major pharmacy chains like Rite Aid and CVS, however, have opted out of the program, saying tight profit margins don’t allow them the luxury of providing discounts to people who would otherwise pay full retail price.

AP-ES-11-26-04 0736EST



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