Sec. 1. 22 MRSA §3174-X is enacted to read:

§3174-X.__Pharmacy services; fees; rates of reimbursement

1.__Fees charged to pharmacies on filing for reimbursement for prescription services.__The department may not impose any processing fee or restructure its reimbursement rate for electronically submitted claims for pharmacy services.

2.__Survey or audit required prior to any change in dispensing fees.__The department must perform an in-depth pharmacy service study prior to any change in the dispensing fee for pharmacy service claims.__This study must determine the full cost of filling a prescription and providing pharmacy services, including reasonable profits derived, in the Maine Medicaid Program, the Cub Care program and the elderly low-cost drug program.__The department must consider the results of this study when determining pharmacy reimbursements.

SUMMARY

In 1995, as part of the Productivity Realization Task Force recommendations, a 25¢ processing fee was imposed on all Medicaid pharmacy claims that were filed electronically. The federal Health Care Financing Administration subsequently ruled that processing fees were not allowed and the enabling statute in Maine was repealed as a result. The Department of Human Services, however, imposed the fee by changing the dispensing fee for Medicaid reimbursement. This bill prohibits the imposition of a processing fee or the restructuring of the reimbursement rate for electronically submitted claims. The bill also establishes a requirement that the Department of Human Services conduct a current cost-of-dispensing survey prior to any subsequent revisions to the dispensing fee.