DHS halts prescription cost curbs
Maine delegation to seek changes to restart plan
Copyright © 2002 Blethen Maine Newspapers Inc.
The Maine Department of Human Services announced Thursday it is suspending a program that reduces prescription drug costs for almost 75,000 low-to moderate-income residents.
The shutdown is effective this morning. But the department is seeking an amended federal waiver that it says will allow the Healthy Maine Prescriptions Program to restart. The decision does not affect 36,000 people enrolled in the Drugs for the Elderly Program, which is connected to the Healthy Maine program.
Another 100,000 people were eligible but did not participate in the program.
The shutdown follows a federal appeals court ruling on Christmas Eve that struck down Healthy Maine. The Pharmaceutical Research and Manufacturers of America brought the suit arguing the program was an illegal expansion of Medicaid.
The decision to shut down the program came in a high level meeting at the state Attorney General's office. Participants included Attorney General Steven Rowe, Human Services Commissioner Kevin Concannon, and a dozen or more lawyers and administrators from both departments, in addition to key outside lawyers involved in Maine's efforts to negotiate prescription drug discounts for its citizens.
"After consultation with the attorney general, we're of the opinion the court has ruled this program invalid under the Social Security Act," said Newell Augur, DHS spokesman. But, he said, the court's ruling was narrow. "We can fix this program."
Augur said participants should not throw away their cards.
"It's a major setback for 110,000 people," said John Carr, president of the Maine Council of Senior Citizens. "You have to understand, folks are trying to scrape together (to pay for their medications)."
Carr said members of the state's Congressional delegation "have to make themselves known to DHS and to the president of the U.S. and say what we need to do is get this program going."
The Healthy Maine Prescriptions program requires pharmaceutical companies to offer discounts, similar to the ones they offer to Medicaid recipients on prescription drugs, to Mainers who earn up to three times the poverty level and sign up for the program. The court sided with the companies.
While Medicaid is supposed to be financed by the federal and state governments, Maine was only contributing 2 percent and the federal government was contributing nothing to the innovative program. And even the state's 2 percent contribution is not guaranteed in Maine law, or in the federal waiver that approved the program in the first place, the court determined.
What the state needs, at a minimum, is for Health and Human Services Secretary Tommy Thompson to amend his earlier approval of the state's program by acknowledging the state will contribute the 2 percent. The state may also need to get the Legislature to affirm that commitment in law.
Felicia Knight, spokeswoman for Sen. Susan Collins, R-Maine, said both Collins and Sen. Olympia Snowe sponsored a bill last session that would allow states to offer just this kind of program, and without the need for a federal waiver. She also noted Thompson has been supportive of the program.
"He was the one who granted the waiver originally," she said. "I'm sure (Collins) will speak to him."
Rep. Tom Allen, D-Maine, said the suspension of the program "is a real tragedy for people in Maine who need help with the cost of their prescriptions."
"The court said in its ruling the other day the drug companies are absorbing the cost. That was the point," he said. People without a prescription drug benefit should have some market power, he said. The Healthy Maine program gave them that.
"We have to keep speaking out," said Allen, who plans to resubmit legislation to provide a federal discount plan. But he doubts the bill will pass. "In time we'll build a political consensus to deal with the problem of price," he said.
Until then, his office helps seniors find ways to buy lower cost prescription drugs from Canada.
The U.S. Supreme Court will hear arguments Jan. 22 in another case PhRMA has brought against the separate Maine Rx Program. Under that program, which has not yet been implemented because of the court action, the state would negotiate on behalf of an estimated 325,000 Mainers without prescription drug benefits.
Even though those Mainers would have to pay with their own money, they would pay prices similar to the discounted prices that Medicaid recipients are charged. Drug companies that don't participate would be penalized.