Sec. PP-1. 5 MRSA c. 165 is enacted to read:
CHAPTER 165
PHARMACEUTICAL COST MANAGEMENT COUNCIL
§2031. Pharmaceutical Cost Management Council
1. Council established. The Pharmaceutical Cost Management Council, referred to in this chapter as "the council," is established and consists of no more than 15 members as follows:
A. The Commissioner of Administrative and Financial Services or the commissioner's designee;
B. The Commissioner of Health and Human Services or the commissioner's designee;
C. The Executive Director of the Workers' Compensation Board or the executive director's designee;
D. One representative of private payors who join the council;
E. One or more members from each of the following publicly funded groups:
(1) The Maine state employees health insurance program, one member representing labor and one member representing management;
(2) The University of Maine System; and
(3) The Maine Community College System;
F. The director of the Governor's Office of Health Policy and Finance or the director's designee or the director of a successor agency;
G. Other public purchasers not listed above. Representatives of municipal or county governments, the Maine Education Association's benefits trust, the Maine School Management Association's benefits trust and private purchasers may be allowed to join the council to participate in savings opportunities;
H. A health care provider; and
I. A clinical pharmacist.
Public purchasers not otherwise listed in this subsection and private purchasers may be allowed to join the council to participate in savings opportunities.
2. Chair and staff assistance. The chair of the council is the director of the Governor's Office of Health Policy and Finance or the director's designee or the director of a successor agency. The chair shall convene the council. The Governor's Office of Health Policy and Finance or a successor agency shall provide necessary staffing services to the council.
3. Purpose. The purpose of the council is to develop options to maximize the cost-effectiveness of the pharmaceutical benefit offered by all health plans that are financed, in whole or in part, with public dollars. A simple majority of all members must be achieved to make final decisions on vendor selection and related matters.
4. Parameters of council. The council shall make recommendations to public purchasers regarding the joint purchasing of pharmaceuticals with the State in order to reduce costs for all participating parties and maximize savings by pooling purchasing power, but not to fundamentally alter the independent nature of any of the health plans involved in the council. Any joint purchasing effort must ensure that:
A. Each of the participating plans retains its distinct nature, with members of each plan maintaining their current medical coverage and participating organizations retaining current contracts, except for amendments required to implement the joint pharmaceutical purchasing effort;
B. The members of participating plans have open access to all prescription drugs, as medically needed. The council shall design and implement a 3-tiered pharmaceutical benefit;
C. Full coverage of certain drugs is contingent upon satisfaction of clinical criteria;
D. A preferred drug list identifies clinically efficacious high-quality prescription drugs that are also cost-effective; these drugs may not require prior approval. The preferred drug list must to the extent possible be based on MaineCare's preferred drug list and must be advised by MaineCare's clinical drug utilization committee;
E. Administrative efficiencies are realized by pooled purchasing; clinically efficacious, cost-effective drugs are preferred; and rebates are negotiated on behalf of the entire group;
F. Reimbursement for prescription generic drugs are capped at maximum allowable costs or the MaineCare bid price, whichever is lower;
G. Incentives may be implemented to reward the use of mail order and community pharmacies will be given the opportunity to provide medications under the same terms as mail-order pharmacies; and
H. All participating plans share in the savings realized through the pooled purchasing effort.
Sec. PP-2. 5 MRSA §12004-G, sub-§14-E is enacted to read:
Sec. PP-3. Calculation and transfer; health insurance savings; pharmaceutical benefit. Notwithstanding any other provision of law, the State Budget Officer shall calculate the amount of savings in section 4, as achieved and implemented by the State Employee Health Commission or from other savings achieved by the State Employee Health Commission consistent with this section, that apply against each General Fund account for all departments and agencies except legislative branch departments and agencies from savings in the cost of health insurance attributable to maximizing the cost effectiveness of the pharmaceutical benefit provided by publicly offered health insurance plans and shall transfer the amounts by financial order upon the approval of the Governor. These transfers are considered adjustments to appropriations in fiscal years 2005-06 and 2006-07. The State Budget Officer shall provide the joint standing committee of the Legislature having jurisdiction over appropriations and financial affairs a report of the transferred amounts no later than November 1, 2005.
Sec. PP-4. Appropriations and allocations. The following appropriations and allocations are made.
ADMINISTRATIVE AND FINANCIAL SERVICES, DEPARTMENT OF
Departments and Agencies - Statewide 0016
Initiative: Reduces funding from projected health insurance savings attributable to maximizing the cost-effectiveness of the pharmaceutical benefit provided by publicly offered health insurance plans.
GENERAL FUND 2005-06 2006-07
Personal Services ($1,361,310) ($2,722,277)
__________ __________
GENERAL FUND TOTAL ($1,361,310) ($2,722,277)
ADMINISTRATIVE AND FINANCIAL SERVICES,
DEPARTMENT OF
DEPARTMENT TOTALS 2005-06 2006-07
GENERAL FUND ($1,361,310) ($2,722,277)
__________ __________
DEPARTMENT TOTAL -
ALL FUNDS ($1,361,310) ($2,722,277)
Sec. PP-5. Appropriations and allocations. The following appropriations and allocations are made.
LEGISLATURE
Legislature
Initiative: Reduces funding from projected health insurance savings attributable to maximizing the cost-effectiveness of the pharmaceutical benefit provided by publicly offered health insurance plans.
GENERAL FUND 2005-06 2006-07
Personal Services ($93,408) ($187,018)
__________ __________
GENERAL FUND TOTAL ($93,408) ($187,018)
LEGISLATURE
DEPARTMENT TOTALS 2005-06 2006-07
GENERAL FUND ($93,408) ($187,018)
__________ __________
DEPARTMENT TOTAL -
ALL FUNDS ($93,408) ($187,018)
LAW AND LEGISLATIVE REFERENCE LIBRARY
Law and Legislative Reference Library
Initiative: Reduces funding from projected health insurance savings attributable to maximizing the cost-effectiveness of the pharmaceutical benefit provided by publicly offered health insurance plans.
GENERAL FUND 2005-06 2006-07
Personal Services ($3,809) ($7,626)
__________ __________
GENERAL FUND TOTAL ($3,809) ($7,626)
LAW AND LEGISLATIVE REFERENCE LIBRARY
DEPARTMENT TOTALS 2005-06 2006-07
GENERAL FUND ($3,809) ($7,626)
__________ __________
DEPARTMENT TOTAL -
ALL FUNDS ($3,809) ($7,626)
OFFICE OF PROGRAM EVALUATION AND GOVERNMENTAL ACCOUNTABILITY
Office of Program Evaluation and Governmental Accountability
Initiative: Reduces funding from projected health insurance savings attributable to maximizing the cost-effectiveness of the pharmaceutical benefit provided by publicly offered health insurance plans.
GENERAL FUND 2005-06 2006-07
Personal Services ($2,795) ($5,723)
__________ __________
GENERAL FUND TOTAL ($2,795) ($5,723)
OFFICE OF PROGRAM EVALUATION AND
GOVERNMENTAL ACCOUNTABILITY
DEPARTMENT TOTALS 2005-06 2006-07
GENERAL FUND ($2,795) ($5,723)
__________ __________
DEPARTMENT TOTAL -
ALL FUNDS ($2,795) ($5,723)
SECTION TOTALS 2005-06 2006-07
GENERAL FUND ($100,012) ($200,367)
__________ __________
SECTION TOTAL -
ALL FUNDS ($100,012) ($200,367)
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