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current contracts, except for amendments required to implement | | the joint pharmaceutical purchasing effort; |
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| | | 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; |
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| | | C. Full coverage of certain drugs is contingent upon | | satisfaction of clinical criteria; |
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| | | 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; |
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| | | 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; |
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| | F. Reimbursement for prescription generic drugs are is | | capped at maximum allowable costs or the MaineCare bid | | price, whichever is lower; |
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| | | 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 |
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| | | H. All participating plans share in the savings realized | | through the pooled purchasing effort. |
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| | | 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. |
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