CHAPTER 611
H.P. 1269 - L.D. 1747
An Act To Amend the Medicaid Drug Rebate Program and the Elderly Low-cost Drug Program
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 22 MRSA §254, sub-§4-A, as amended by PL 2003, c. 20, Pt. GGG, §3, is repealed and the following enacted in its place:
4-A. Payment for drugs provided. The commissioner may establish the amount of payment to be made by the program and by recipients of the program toward the cost of drugs and medications furnished under the program, including covered prescription and nonprescription drugs, medications and medical supplies, under the following terms.
A. For the basic component of the program, the total cost to a recipient for the purchase of any covered drug or medication may not exceed the sum of $2 plus 20% of the price allowed for that drug or medication under program rules.
B. For the supplemental component of the program, the total cost to a recipient for the purchase of any covered drug or medication may not exceed:
(1) For a brand name drug or medication, the cost of the program for that drug or medication minus the $2 paid by the program; and
(2) For a generic drug or medication, the sum of $2 plus 20% of the price allowed for that drug or medication under program rules.
C. For the catastrophic program, the commissioner shall establish annual limits on the costs incurred by recipients for drugs and medications covered under the program on or prior to May 31, 2001. After the limit is reached, the program shall pay 80% of the cost of each drug and medication covered by the supplemental component of the program on May 31, 2001 minus $2. Any remaining amount is paid by the recipient. The limits must be set by the commissioner by rule as necessary to operate the program within the program budget;
Sec. 2. 22 MRSA §3174-R, as enacted by PL 1997, c. 643, Pt. RR, §5, is amended to read:
§3174-R. Medicaid drug rebate program
The department shall enter into a drug rebate agreement with each manufacturer of prescription drugs under the Medicaid program in accordance with Section 1927 of the federal Social Security Act, as long as the agreements are consistent with state and federal law, are approved by the federal Health Care Finance Administration and result in a net increase in rebate revenue available to the Maine Medicaid Program. Individual rebate agreements may vary. The department shall seek to achieve an aggregate rebate amount from all agreements that is at least 6 percentage points higher than the percentage of the total Medicaid drug expenditures that the rebates would otherwise be under Section 1927 of the federal Social Security Act. Any increase in revenue from the Medicaid drug rebate program over accepted estimates as of the effective date of this section that results in a higher percentage of the total Medicaid drug rebates must be reserved to provide coverage pursuant to section 3174-G, subsection 1-A. In the event that the department is not able to achieve the rebate amount required by this section without compromising the best interest of Medicaid recipients and the Medicaid drug rebate program, the department shall report to the joint standing committee of the Legislature having jurisdiction over health and human services matters and the joint standing committee of the Legislature having jurisdiction over appropriations and financial affairs in the next regular session of the 119th Legislature.
Effective July 30, 2004, unless otherwise indicated.
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