Federal Appeals Court Panel Raises Concerns Over Maine Prescription Drug Discount Program
Two of the three judges on a panel of the U.S. Circuit Court of Appeals for the District of Columbia yesterday said that they may have to overturn a Maine program that provides prescription drug discounts to uninsured residents, the Portland Press Herald reports (Jansen, Portland Press Herald, 12/6). Healthy Maine Prescriptions, launched last June, uses a federal Medicaid waiver to provide discounts of as much as 25% on prescription drugs for about 108,000 uninsured Maine residents with incomes less than 300% of the federal poverty level who do not qualify for Medicaid. The Pharmaceutical Research and Manufacturers of America filed suit in federal court to block Healthy Maine (American Health Line, 5/13). U.S. District Court Judge Ricardo Urbina upheld the program in February. In the case, PhRMA attorney John Roberts argued that HHS never approved the state's contribution to Healthy Maine -- 2% of prescription drug costs, or about $500,000 per year -- in the Medicaid waiver. Maine agreed to pay the contribution last year after the D.C. circuit court overturned a Vermont program similar to Healthy Maine. Two of the judges on the panel yesterday said that HHS Secretary Tommy Thompson never approved the 2% contribution. Sushma Soni, an attorney with the Department of Justice, said that Thompson raised no objections about the contribution. She added that experimental programs such as Healthy Maine are "routinely changed" after approval and that Thompson has the authority to allow the 2% contribution, the Herald reports.
The appeals court judges also raised concerns that Maine officials could end or reduce the state's contribution to Healthy Maine in the future. "Next month they could put in $10,000," Judge Raymond Randolph said. In addition, the judges questioned whether the 2% contribution was "sufficient," the Herald reports. PhRMA said that without a federal contribution under a formal extension of Medicaid, state contributions would not provide adequate funds to "trigger rebates," the Herald reports. However, the judges said that programs such as Healthy Maine could "potentially be permitted" without federal contributions, the Herald reports (Portland Press Herald, 12/6). PhRMA also said that Healthy Maine represents an "illegal and unjustified expansion" of Medicaid, the Herald reports. "Nothing in the act authorizes (HHS) to create an entirely new class of persons who obtain benefits under the program but who are not program beneficiaries," Jeffrey Pariser, an attorney for PhRMA, wrote. Colorado, Hawaii, Maryland, Massachusetts, New Mexico, New York, Vermont, Washington and Wisconsin may enact programs similar to Healthy Maine based on the result of the case, according to the National Conference of State Legislatures (Jansen, Portland Press Herald, 12/5). Legal analysts expect a decision in the case early next year, the Associated Press reports (Associated Press, 12/6).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.