CHAPTER 343
H.P. 923 - L.D. 1324
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 5 MRSA §2031, sub-§§1 and 4, as enacted by PL 2005, c. 12, Pt. PP, §1, are amended to read:
1. Council established. The Pharmaceutical Cost Management Council, referred to in this chapter as "the council," is established and consists of
no more than15 voting members appointed by the Governor 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 member 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 Two 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.; and
J. Three consumers of health care services, one of whom represents a statewide organization that advocates for enrollees in a publicly funded health program that includes comprehensive prescription drug benefits.
Public Representatives of municipal or county governments, the Maine Education Association's benefits trust, the Maine School Management Association's benefits trust and other public purchasers not otherwise listed in this subsection and private purchasers may be allowed to join the council as nonvoting members and to participate in savings opportunities.
4. Duties 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. The council shall coordinate and exchange information among state agencies, stakeholder groups, advisory committees, organizations and task forces looking into options for reducing the cost of prescription drug benefits. 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 is 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 are 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. 2. Report. By February 1, 2006, the Pharmaceutical Cost Management Council established in the Maine Revised Statutes, Title 5, section 2031 shall report to the joint standing committee of the Legislature having jurisdiction over health and human services matters regarding its work and findings with regard to cost containment tools, including, but not limited to, academic detailing and evidence-based prescribing.
Effective September 17, 2005.
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