Usa Maine

USA Statutes : maine
Chapter : Chapter 165. PHARMACEUTICAL COST MANAGEMENT COUNCIL (HEADING. PL 2005, c. 12, Pt. PP, @1 (new))
Title 5 - §2031. Pharmaceutical Cost Management Council


§2031. Pharmaceutical Cost Management Council

1. Council established. The Pharmaceutical Cost Management Council, referred to in this chapter as "the council," is established and consists of 15 voting members appointed by the Governor as follows:

A. The Commissioner of Administrative and Financial Services or the commissioner's designee; [2005, c. 12, Pt. PP, §1 (new).]

B. The Commissioner of Health and Human Services or the commissioner's designee; [2005, c. 12, Pt. PP, §1 (new).]

C. The Executive Director of the Workers' Compensation Board or the executive director's designee; [2005, c. 12, Pt. PP, §1 (new).]

D. One representative of private payors who join the council; [2005, c. 12, Pt. PP, §1 (new).]

E. One 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;
[2005, c. 343, §1 (amd).]

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; [2005, c. 12, Pt. PP, §1 (new).]

G. Two public purchasers not listed above; [2005, c. 343, §1 (amd).]

H. A health care provider; [2005, c. 343, §1 (amd).]

I. A clinical pharmacist; and [2005, c. 343, §1 (amd).]

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. [2005, c. 343, §1 (new).]

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 listed in this subsection and private purchasers may be allowed to join the council as nonvoting members and to participate in savings opportunities. [2005, c. 343, §1 (amd).]

2. Chair and staff assistance. The chair of the council is the director of the Governor's Office of Health Policy and Finance or the director's designee or the director of a successor agency. The chair shall convene the council. The Governor's Office of Health Policy and Finance or a successor agency shall provide necessary staffing services to the council. [2005, c. 12, Pt. PP, §1 (new).]

3. Purpose. The purpose of the council is to develop options to maximize the cost-effectiveness of the pharmaceutical benefit offered by all health plans that are financed, in whole or in part, with public dollars. A simple majority of all members must be achieved to make final decisions on vendor selection and related matters. [2005, c. 12, Pt. PP, §1 (new).]

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; [2005, c. 12, Pt. PP, §1 (new).]

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; [2005, c. 12, Pt. PP, §1 (new).]

C. Full coverage of certain drugs is contingent upon satisfaction of clinical criteria; [2005, c. 12, Pt. PP, §1 (new).]

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; [2005, c. 12, Pt. PP, §1 (new).]

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; [2005, c. 12, Pt. PP, §1 (new).]

F. Reimbursement for prescription generic drugs is capped at maximum allowable costs or the MaineCare bid price, whichever is lower; [2005, c. 343, §1 (amd).]

G. Incentives may be implemented to reward the use of mail order, and community pharmacies are given the opportunity to provide medications under the same terms as mail-order pharmacies; and [2005, c. 343, §1 (amd).]

H. All participating plans share in the savings realized through the pooled purchasing effort. [2005, c. 12, Pt. PP, §1 (new).]

[2005, c. 343, §1 (amd).]

Section History:
PL 2005,
Ch. 12,
§PP1 (NEW).
PL 2005,
Ch. 343,
§1 (AMD).
The Revisor's Office cannot provide legal advice or interpretation of Maine law to the public. If you need legal advice, please consult a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007

USA Statutes : maine