If the dispute over the rebate amount is not resolved, a request for a hearing with supporting documentation must be submitted to the Administrative Hearings Unit. Failure to resolve the dispute may be cause for terminating the drug rebate agreement and denying payment to the pharmaceutical manufacturer for any drugs.

Any prescription drug of a manufacturer that does not enter into an agreement is not reimbursable unless the department determines the prescription drug is essential.

All prescription drugs of a pharmaceutical manufacturer that enters into an agreement pursuant to this subsection that appear on the list of approved drugs under this program must be immediately available and the cost of the drugs must be reimbursed and is not subject to any restrictions or prior authorization requirements, except as provided in this paragraph. If the commissioner establishes maximum retail prices for prescription drugs pursuant to section 2693, the department shall adopt rules for the elderly low-cost drug program requiring the use of a drug formulary and prior authorization for the dispensing of certain drugs to be listed on a formulary. Rules adopted pursuant to this paragraph are routine technical rules as defined in Title 5, chapter 375, subchapter II-A.

Sec. 2. 22 MRSA §2681, first ¶, as enacted by PL 1999, c. 786, Pt. A, §3, is amended to read:

The Maine Rx Program, referred to in this subchapter as the "program," is established to reduce prescription drug prices for residents of the State. The program is designed for the State to utilize manufacturer rebates and pharmacy discounts to reduce prescription drug prices. In implementing the program, the State shall serve as a pharmacy benefit manager in establishing rebates and discounts on behalf of qualified residents.

Sec. 3. 22 MRSA §2681, sub-§2, ¶B, as enacted by PL 1999, c. 786, Pt. A, §3, is repealed.

Sec. 4. 22 MRSA §2681, sub-§2, ¶G, as enacted by PL 1999, c. 786, Pt. A, §3, is amended to read:

G. "Secondary discounted Discounted price" means a price that is equal to or less than the initial discounted retail

price minus the amount of any rebate paid by the State to the participating retail pharmacy.

Sec. 5. 22 MRSA §2681, sub-§5, ¶B, as enacted by PL 1999, c. 786, Pt. A, §3, is repealed.

Sec. 6. 22 MRSA §2681, sub-§5, ¶C, as enacted by PL 1999, c. 786, Pt. A, §3, is amended to read:

C. No later than October 1, 2001, a participating retail pharmacy shall offer the secondary discounted price.

Sec. 7. 22 MRSA §2693, as enacted by PL 1999, c. 786, Pt. A, §3, is repealed.

Sec. 8. 22 MRSA §3173, 13th ¶, as repealed and replaced by PL 1979, c. 127, §144, is amended to read:

The Department of Human Services may establish fee schedules governing reimbursement for services provided under this chapter. In establishing the fee schedules, the department shall consult with individual providers and their representative associations. The fee schedules shall be are subject to annual review. The fee schedule for pharmacies must include, in addition to the reimbursement, payment of a dispensing fee in the amount of $6.50 for each prescription filled.__The amount of this dispensing fee must increase by $1 for each percentage point reduction in the reimbursement for prescription drugs.

Sec. 9. 22 MRSA §3174-Y, as enacted by PL 1999, c. 786, Pt. B, §3, is repealed.

Sec. 10. 24 MRSA §2502, sub-§1-A, as enacted by PL 1985, c. 804, §§3 and 22, is amended to read:

1-A. Health care practitioner. "Health care practitioner" means physicians and all others certified, registered or licensed in the healing arts, including, but not limited to, nurses, podiatrists, optometrists, chiropractors, physical therapists, dentists, psychologists, pharmacists and physicians' assistants.

Sec. 11. 24-A MRSA §2703-A is enacted to read:

§2703-A.__Identification card required

Every health insurer that issues a policy in this State that includes a prescription drug benefit shall provide an identification card to the policyholder that conforms to uniform content and format requirements determined by rule by the superintendent.__Rules adopted pursuant to this section are

routine technical rules as defined in Title 5, chapter 375, subchapter II-A.

SUMMARY

This bill makes the following changes to the laws governing pharmacies.

1. It amends the Maine Rx Program to eliminate discounts that are borne by pharmacies in this State, leaving the discounts that are funded from rebates paid by drug manufacturers.

2. It requires the Department of Human Services to provide a dispensing fee to pharmacies in a designated amount for prescriptions that are filled for patients who participate in the Medicaid program.

3. It specifically names pharmacists as health care practitioners under the Maine Health Security Act.

4. It requires health insurers who provide a pharmacy benefit to provide identification cards to their policyholders that conform to a uniform format determined by the Superintendent of Insurance.