By Bonnie Washuk,Staff Writer

INDIAN ISLAND – On Thursday, an old factory building on the Penobscot Nation’s Indian Island sat empty and quiet.

That’s expected to change later this month. Giant pill-dispensing machines will be filled with multi-colored capsules. High-tech security cameras will watch workers fill plastic pill bottles. A call-in help desk staffed by pharmacists and technicians will process orders and answer questions from doctors and patients.

Maine’s new prescription mail-order business, PIN Rx, will open.

“You won’t be able to drive up and order drugs. They’ll all be ordered through the phone and computers,” said Mark A. Chavaree, Penobscot tribal member, attorney and PIN Rx president. Maintenance prescriptions in 90-day quantities will arrive at customers’ doors.

To the chagrin of retail Maine pharmacies, the state wants to explode the growth of mail-order prescription sales for 364,000 Mainers in three state programs: MaineCare, Drugs to the Elderly and Maine Rx Plus, said Jude Walsh, who oversees prescription programs for the Governor’s Office of Health Policy and Finance.

The state hopes to save $5 million in prescription drug costs yearly from the change. Buyers are also expected to save money on their prescriptions.

Initially, 14 workers will staff PIN Rx, which has a mail-order agreement with the state. “We’re starting out small,” Chavaree, said. As the business grows, more workers will be hired, he said.

Only maintenance drugs – for chronic conditions like diabetes, high blood pressure and high cholesterol – will be sold by PIN Rx, not acute care drugs like pain killers and antibiotics.

Currently, only about $5 million worth of prescriptions are bought annually through the mail by people in the state programs, Walsh said. The state wants mail orders to mushroom to $100 million a year. The total value of prescriptions bought in the three programs is $360 million a year.

“Once PIN Rx is up and running, we’ll let people know there is an alternative and that there are incentives,” Walsh said, adding that people will see PIN Rx advertising on television. A large media buy will happen in October, she said.

The goal: The state will save by paying less in prescription fees to PIN Rx than it currently does to retail pharmacies, Walsh said. In addition, MaineCare clients, who make up the bulk of the three programs, will save by having no co-payments, Drugs to the Elderly clients will have lower co-payments and those in the Maine Rx program will have lower drug costs, Walsh said.

But Maine pharmacists say if the state is successful, retail pharmacies will lose.

If the state achieves the savings it’s projecting, that will pull $100 million of annual business from retail pharmacies and “more pharmacies will close,” said Robert Morrissette, past president of Maine Pharmacy Association, and president of Pharmacy Group of New England in Scarborough.

Already 14 pharmacies have closed in Maine in the last two years, victims of state cuts in fees paid to pharmacies, Morrissette said.

Michael Nadeau, pharmacist and owner of Bedard’s Pharmacy in Lewiston, agreed.

“As an independent pharmacy, I don’t like it. This will pull a lot of business from us. I’m now doing 70 percent MaineCare. If you pull that, that’s huge. That will hurt. I’m one of the last survivors in the greater Lewiston area of independent pharmacies.”

The state wants to yank the easier, quicker work from pharmacies, leaving them to fill acute, more time-consuming prescriptions, ones that involve more interaction with patients, Nadeau said. Last weekend alone, Nadeau said, he had to clear up four prescriptions that customers initially ordered through a large national chain that had not arrived or had other problems. “They want us to pick up the pieces,” Nadeau said.

Morrissette predicted that the state will not get the projected savings. It’s happened before, he said.

Two years ago the state encouraged MaineCare clients to buy through the mail from Wal-Mart in Texas. The state projected $5 million in annual savings, but never realized those savings, Morrissette said.

“And Wal-Mart knows what they’re doing. If anybody could get the savings it would be them,” Morrissette said. The PIN Rx will be a start-up operation. “The Penobscots don’t know anything about pharmacy. They don’t know anything mail order. Yet the administration … thinks they’re going to save money,” Morrissette complained.

State officials counter that Maine has enough prescription business for both retail pharmacies and a Maine mail-order business.

As a state employee, Walsh said she already has access to lower co-pays by buying through the mail. Next year people on Medicare will be encouraged to buy through the mail. Walsh said people on the three state programs should also have a chance to save and have medicine delivered to their doors.

“All we’re offering in a voluntarily way is use of mail for people who don’t have transportation, have a chronic illness, low income” and who can save with no co-payments.

The state hasn’t achieved the savings it projected with Wal-Mart in Texas, Walsh said, because Texas laws are different than Maine and only allow prescriptions filled by doctors. Maine law allows prescriptions to be filled by health professionals other than doctors, such as physicians assistants, Walsh said. When the state discovered that, it stopped encouraging clients to send prescriptions to Texas, Walsh said.

Meanwhile, the state is working to help pharmacies, especially rural ones, expand their business without adding more stores, Walsh said. For instance, new programs are taking advantage of technology to allow pharmacies to fill the prescriptions and patients to receive medicine at their doctors’ offices.

Chavaree acknowledged there are hard feelings by pharmacies, but said the mail-order trend is here.

“This is coming whether the tribes do it or not. Why not create the jobs in Maine? We’re part of the Maine economy. Mail order is here already. We’d like to provide that service to Maine as a Maine-based company and as a tribe that’s lived here for thousands of years.”

Initially the Indian Island drug warehouse was going to help the state buy cheaper drugs from Canada. Because the federal government now considers that illegal, the state began to explore a mail-order business in Maine, Chavaree said.

The idea of using the business to import cheaper drugs from Canada will continue to be explored, Chavaree said. In addition, eventually, mail-order drugs through PIN Rx could be offered to other groups and businesses, not just people in the three state programs.

“I’m excited about it,” Chavaree said. “We haven’t had too many economic successes in the past.” Mail-order drugs is a good fit with the tribe, he said. It would help the elderly who have difficulty getting to pharmacies, “and we don’t see an impact to the environment.”

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