LD 1634
pg. 2
Page 1 of 9 An Act To Improve the Maine Rx Program Page 3 of 9
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LR 2173
Item 1

 
A. "Average wholesale price" means the wholesale price
charged on a specific commodity that is assigned by the drug
manufacturer and is listed in a nationally recognized drug
pricing file.

 
A-1.__"Covered drugs" means drugs that are on the MaineCare
preferred drug list established and revised from time to
time by the department pursuant to its authority to operate
the MaineCare program.

 
B. "Initial discounted price" for a drug means a price that
is less than or equal to the average wholesale price, minus
6%, plus the dispensing fee provided under the Medicaid
program under this Title the price the department pays
MaineCare participating retail pharmacies for that drug for
MaineCare members.

 
C. "Labeler" means an entity or person that receives
prescription drugs from a manufacturer or wholesaler and
repackages those drugs for later retail sale and that has a
labeler code from the federal Food and Drug Administration
under 21 Code of Federal Regulations, 207.20 (1999).

 
D. "Participating retail pharmacy" or "retail pharmacy"
means a retail pharmacy located in this State, or another
business licensed to dispense prescription drugs in this
State, that participates in the program and that provides
discounted prices to residents as provided in subsection 5.

 
E. "Pharmacy benefit manager" means an entity that procures
prescription drugs at a negotiated rate under a contract.

 
F. "Qualified resident" means a resident of the State who
has obtained from the department a Maine Rx enrollment card
a family income equal to or less than 350% of the federal
poverty level and who is enrolled in the program.
"Qualified resident" also means a resident of the State
whose family incurs unreimbursed expenses for prescription
drugs that equal 5% or more of family income or whose total
unreimbursed medical expenses equal 15% or more of family
income.__For purposes of this paragraph, the cost of drugs
provided under this subchapter is considered an expense
incurred by the family for eligibility determination
purposes.

 
G. "Secondary discounted price" means a price that is equal to
or less than the initial discounted price minus the amount of any
rebate paid by the State to the participating


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