| Governor’s New Medicaid
Supplemental Drug Rebate Pool — 
Governor Baldacci
visited seniors and disabled citizens to reassure them that the state will continue to pay
to offset Medicare Part D faults.
by Ramona du Houx
What was billed as way to help
America’s senior citizens obtain their prescription drugs at lower rates has turned
into an administrative nightmare that continues to benefit the drug companies more than
our senior citizens.
"I cannot allow seniors to not get the
medicines they need. A person who does not get a life-sustaining drug could end up
hospitalized or even die. I can’t let that happen," said the governor. "I
won’t let that happen." And he has been true to his word.
The ills that have plagued America since
the federal government announced its new program, Medicare Part D, started back in
November ’05; that’s when Governor Baldacci starting making plans and announced
a help line to assist seniors.
With Medicare Part D, Maine is outlawed
from continuing Medicaid coverage for people who are dually eligible for Medicaid and
Medicare.
Maine was the first state in the country to
create a safety net for Part D recipients. This ensured that Maine’s seniors would
continue to get the drugs they need while complications were fixed at the federal level.
In addition, the state is continuing to
help Maine’s lowest-income seniors afford the costs of the Part D benefit. "We
are helping with premiums, deductibles, co-pays, and the ‘doughnut hole’ —
the point at which Part D does not cover any drug costs until a recipient’s
out-of-pocket costs exceed a certain amount, often occurring between $1,200 and
$2,500," said Jude Walsh of the Governor’s Office of Health Policy and Finance.
The state is covering 80 percent of the costs recipients incur while in the doughnut hole.
Not satisfied with the federal
government’s response to prescription drug costs the governor took action. Over the
summer Baldacci announced his innovative first-ever, state-led supplemental drug rebate
pool through Medicaid.
The drug-buying collaborative, known as the
Sovereign States Drug Consortium, started purchasing drugs last November and has already
saved Maine’s Medicaid program more than $1 million and is expected to save $5
million once the program is fully operational. Iowa, Maine, and Vermont make up the SSDC.
The Baldacci administration has been
involved in discussions with seven other states that may be interested in joining the
consortium.
Walsh said the consortium allows the three
states to negotiate directly with 58 drug manufacturers for more than 1,300 medications.
It also limits the role of drug purchasing organizations, called "pharmacy benefit
managers," in order to make sure the states get all of the negotiated savings.
The federal Center for Medicare and
Medicaid Services is allowing the drug negotiation arrangement, even though the
legislation that created the Medicare Part D program specifically bars the federal
government from entering into such negotiations.
Iowa Governor Tom Vilsack joined Gov. John
Baldacci to express his gratitude for leading the way with the consortium and with Dirigo
Health.
"This particular program has
saved my state $11 million," said Vilsack, "So I’m here to thank
John." Vilsack said the pool is particularly advantageous to smaller states that lack
extensive purchasing power. Praising Baldacci as a national leader among governors on
health-care-related issues, Vilsack said he modeled a program in his state that has
expanded coverage to 15,000, uninsured residents after Dirigo.
Dirigo Health has provides coverage
for more than 16,200 people and more than 2,300 businesses since it started in 2005. Over
the past two years, more than $78 million of savings to the Maine health-care system have
been directly attributed to Dirigo.
Recently Baldacci announced that the
federal government has certified DirigoChoice as an insurance product for purposes of
federal Health Coverage Tax Credits (HCTC). The HCTC program is open to qualified
employees who were laid off from their manufacturing jobs due to foreign trade and are
eligible to receive trade readjustment assistance.
"The
federal government’s certification of DirigoChoice will increase access to affordable
health insurance for those in Maine who have been laid off through no fault of their
own," said Governor Baldacci. "I am pleased that DirigoChoice is now a certified
HCTC program."
Dirigo Health is moving forward with
the blue ribbon commission appointed by the governor. And affordable drug coverage is also
moving in the right direction with the governor’s new innovative SSDC.
"Unlike the Medicare Drug Benefit,
states have control over what we cover under Medicaid and how much we pay for it. The
preservation of the benefit we provide our citizens is a top priority. We must control
spending to be able to afford that coverage," stated a letter issued by the SSDC.
"We can’t go it alone; we are a small state with
1.3 million people; we need to work together to pool our resources," said the
governor. "In a Medicaid drug rebate pool, states leverage their collective covered
lives to negotiate for discounts in drug costs. We are stronger working together." |
