An Act To Establish the Maine Prescription Drug Affordability Board
Sec. 1. 5 MRSA c. 167 is enacted to read:
MAINE PRESCRIPTION DRUG AFFORDABILITY BOARD
§ 2041. Maine Prescription Drug Affordability Board established
(1) A direct financial benefit of any amount deriving from the results or findings of a study or determination by or for the board; or
(2) A financial benefit from individuals or companies that own or manufacture prescription drugs, services or items to be studied by the board that in the aggregate exceeds $5,000 per year. For purposes of this subparagraph, "financial benefit" includes honoraria, fees, stock or other financial benefit and the current value of the member's or immediate family member's already existing stock holdings, in addition to any direct financial benefit deriving from the results or findings of a review conducted under this section.
(1) By the board in the employment of board senior staff;
(2) By the Governor, President of the Senate or Speaker of the House of Representatives when appointing members to the board and advisory council established pursuant to subsection 11;
(3) By the board, describing any recusals as part of any final decision resulting from a review of a prescription drug; and
(4) By the 5th day after a conflict is identified or, if a public meeting of the board will occur within that 5-day period, in advance of the public meeting.
(1) Four members are appointed by the President of the Senate: one member representing physicians; one member representing nurses; one member representing hospitals; and one member representing health insurers;
(2) Four members are appointed by the Speaker of the House of Representatives: one member representing a statewide health care advocacy coalition; one member representing a statewide advocacy coalition for seniors; one member with expertise in health services research specializing in prescription drugs; and one member representing the public; and
(3) Three members are appointed by the Governor: one member representing pharmaceutical manufacturers; one member representing employers; and one member representing pharmacists.
§ 2042. Required manufacturer notice of introductory price and price increases
§ 2043. Criteria for selection of prescription drugs for review of cost
§ 2044. Determining excess costs to payors and consumers
§ 2045. Board determinations, compliance and remedies
§ 2046. Appeals
§ 2047. Annual reports
Beginning January 1, 2021, and annually thereafter, the board shall report to the Governor, the Legislature and the public on general prescription drug price trends, the number of manufacturers required to provide notice under section 2042 because of prescription drug pricing decisions and the number of prescription drugs that were subject to board review and analysis, including the results of that analysis, as well as the number and disposition of appeals and judicial reviews.
Sec. 2. 5 MRSA §12004-G, sub-§14-I is enacted to read:
|Health care||Maine Prescription Drug Affordability Board and advisory council||Legislative Per Diem and Expenses||5 MRSA §2041|
This bill creates the Maine Prescription Drug Affordability Board to determine the reasonableness of the costs for certain prescription drug products. The bill requires prescription drug manufacturers to notify the board when the introductory price or proposed price increase for a brand-name or generic drug reaches a specified threshold. The board is directed to review the information submitted by manufacturers to justify the price or increase.
The bill requires the board to have a public process for each prescription drug required to be reviewed based on certain criteria. The board is directed to determine if the cost to the health care system of appropriate utilization of a drug is commensurate with its benefit to the system and whether the drug is affordable to state residents. If the board finds that the cost in the State is not affordable to state health care systems and state residents, the board is authorized to establish a cost or payment rate for the drug to which all state programs, local governments, licensed commercial health plans, including state marketplace plans, licensed pharmacies, wholesalers and distributors must abide. These covered entities are prohibited from paying more for the drugs than the board-established rate.