An Act To Reimburse Pharmacies under the MaineCare Program Based on Wholesale Acquisition Costs

Emergency preamble. Whereas,  acts and resolves of the Legislature do not become effective until 90 days after adjournment unless enacted as emergencies; and

Whereas,  the adequate reimbursement of pharmacies for dispensing prescription drugs under the MaineCare program is critical to the financial stability of the pharmacies; and

Whereas,  as a result of the settlement of litigation in the First DataBank and MediSpan case in which First DataBank and MediSpan were ordered to reduce the average wholesale price used in determining pharmacy reimbursement beginning September 26, 2009 in the federal Medicaid program, pharmacy reimbursement will be suddenly reduced, with the possible result of destabilizing the pharmacies of Maine and patient access to pharmacy services; and

Whereas,  in the judgment of the Legislature, these facts create an emergency within the meaning of the Constitution of Maine and require the following legislation as immediately necessary for the preservation of the public peace, health and safety; now, therefore,

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

§ 3174-PP.  MaineCare pharmacy reimbursement

Emergency clause. In view of the emergency cited in the preamble, this legislation takes effect when approved.

SUMMARY

This bill requires the Department of Health and Human Services to reimburse pharmacies for dispensing covered brand name and generic drugs under the MaineCare program based on a formula that includes calculated wholesale acquisition cost plus 6.7% and a dispensing fee of $3.35 per prescription and allows the department to adopt routine technical rules. The formula applies to drugs dispensed under the MaineCare program on or after September 26, 2009.