Over the past year, the cost of prescription drugs has become a white-hot issue in state legislatures across the country. The issue is now a focus of the presidential race. Stateline.org spoke by telephone with Maine Senate Majority Leader Chellie Pingree, a Democrat who spearheaded the effort behind the Pine Tree State's first-in-the-nation price-control law for prescription drugs, to talk about the new Maine law, about how the issue has taken off and what's likely to happen next.
Stateline.org: Could you give a basic description of the law, what it does and who it serves in your own words?
Pingree: The Maine law is really in two parts, and the first part we like to call sort of the all-American plan. We are attempting to do what all other HMOs and PBMs (pharmaceutical benefits managers) are doing to right now, and that's use our market leverage to negotiate lower prices with the pharmaceutical manufacturers. So we're looking at a population of about 325,000 citizens, which is our estimate right now of those who are uninsured and underinsured. And adding that to the Medicaid population and our Drugs For the Elderly program, our state-subsidized program for seniors, together that's about a half million people in a state of 1.2 million people, so a substantial population. And our law requires that we make available to all Maine residents the Maine Rx card (that's what we call the program) after January 1. And they can go to their pharmacy, and they can access discounts. We're hoping that in the beginning we can give them discounts similar to what we're able to offer in the Medicaid program minus our administrative costs. And then the law states that we will attempt to negotiate bigger discounts from the pharmaceutical industry and use the services of a pharmaceutical benefits manager, actually contract with one or hire one to do that work. So that's part A. Part B is sort of what we've often called the "stick," or what happens if the manufacturers won't participate with us and work with us. And that's our emergency pricing board, which goes into effect in January of 2003. And we'll really look at finding a way to require that pharmaceutical manufacturers that want to sell in the state of Maine do so at a price that's comparable to the lowest prices they're giving either residents of Canada, the federal government through the federal supply schedule or the HMOs. So we kind of are looking at a composite of those prices.
Stateline.org: Our second question is why now? Why this year, and what made the timing right?
Pingree: Well, two reasons. You know, our original idea was to kind of move the political debate in our state for a problem that we knew was growing. But we didn't know until we got into it just how big it was and how angry citizens were. And we knew it for two reasons: 1. that our state pays most of the bills now for senior citizens who don't have access to drugs. Besides the Medicaid program, there is no federal funding available. As you know there's no Medicare benefit, but there's no federal funding for those people who make more than Medicaid recipients but not enough to pay the cost of their drugs. So we [pay for drugs] like many other states--I think there's 27 states that have benefit programs for our seniors and disabled, and they're all [paid for with] state dollars. So 1. we were paying the bills, and 2. we were hearing from constituents at an alarming rate. You know, by our estimates and what we read, the cost of prescription drugs has doubled in the last six years, so you can imagine how many more people are saying to us, "We can't afford the drugs, and we're making those difficult choices that you hear about all the time. You know, should I buy my food, should I buy my oil this month, or should I pay for the cost of drugs." We then started holding public meetings to discuss this bill all over the state, and we were frankly shocked at how many seniors came forward to tell us painful stories. We heard from family members. And we heard from practitioners, doctors who said to us, "I'm writing these prescriptions, and I know they're not being filled and my patients often aren't telling me that they're not even taking the drugs I prescribed." So we were a little surprised at the level of interest both from citizens, practitioners, and then local newspapers and press. And it was somewhat coincidental that it turned out to be an extremely important political issue this year. Maine just happened to be the state that moved legislation forward that, again, started out as a bold idea and ended up as unanimous bipartisan vote. So we didn't anticipate what would happen this year.
Stateline.org: How did you get it done in Maine that quickly? What was the coalition that you built to get the law enacted and convince the governor?
Pingree: Well, all members of Democratic leadership started off on board. And that's a really important point because when you chose to take on an industry this big, you're also saying, "We're going to get along without your campaign contributions." And for all members of leadership, raising money is an important part of our job. Because we came to that agreement early, it might sound insignificant but that's a very important decision to make and that was No. 1.
No. 2 we had broad bipartisan support because there were many seniors speaking to their individual legislators, and we did these public forums with both Republicans and Democrats, so everybody was hearing the same stories at the same time. So we built a bipartisan coalition, even with members of the minority party. And then there was tremendous newspaper support for it as they learned more about the issue and came to these forums. I think that helped us a lot. Frankly, there are no good arguments on the other side of the debate, which helps a lot when you're listening to seniors and doctors every day and you hear from the industry that they need the money. Their arguments didn't hold up compared to the basic health and safety issues we were hearing from citizens.
Stateline.org: PHRMA (Pharmaceutical Research and Manufacturers of America) has gone to court to try and tie this up. Is that possible? Will the law go into effect even as that litigation proceeds?
Pingree: Well, the law went into effect in August. And we have the commissioner's office and the governor's office working very hard on implementing this law. We've already put out an RFP for a PBM, if you know what I mean--a request for proposal for a pharmaceutical benefits manager. Part of the law suggested that we also do that with all the northern New England states, so we actually put out an RFP with Maine, New Hampshire and Vermont. Even though we have differing needs, our governors have been meeting together to do that so that progress is definitely moving forward. We're designing the outreach plan card that people will use in January. I mean, we're proceeding with the program as if it's all going to happen. Our attorney general along with a lot of people outside of the attorney general's office who are interested in helping are working on our answer to PHRMA's complaint, which went in on Monday [Sept. 11]. Monday is just the answer to the injunction, and if we're able to win on the injunction, which I think we have a good prospect of doing, it will still go to court, but we can continue implementing our program without any delays.
Stateline.org: I know there are some other states that are talking about modeling legislation after the Maine law in the next legislative session. Have people contacted you for guidance on this?
Pingree: Oh, absolutely. Ever since May--I'm in an airport right now--I have been traveling all over the country from Arizona to Texas to Pennsylvania to New York state. I've testified in public hearings in other states. I've met with groups of legislators. I've spoken at conferences from academic interests to the American Medical Association (AMA). The interest is phenomenal. We can't answer all the telephone calls, and go to all the meetings, and offer enough assistance to all the people and all the states that want to do it.
Stateline.org: Any indication of what states that it will go to next?
Pingree: Well, I think it will be active in Vermont, Minnesota, Missouri, Pennsylvania, New York, Texas. I mean, I don't know that every one will go exactly for the Maine bill. In fact, we hope that each state gets a little more creative and finds another way to go about doing this. I think we'll see a lot of different proposals out there come January. ... Although Pennsylvania and New York actually have bills in play because they're year-round legislatures. But I think mostly nothing happens till after elections.
But there's no question--just the level of activity and the amount of materials we send out. And again it's not just states, it's interest groups, like the AMA, public health associations and a lot of different groups. It's no surprise it's this year's biggest political issue because it's just really on people's minds.
Stateline.org: Both presidential candidates have taken up the issue. Do you feel that they're addressing it adequately or are there ways that each of them could do it better?
Pingree: Well, I don't think that the Republican plan that requires insurance coverage is a realistic solution. From all I've heard and read, it's a way to talk about the issue but not solve the problem. I think that the proposal frankly has to be, whoever decides to do this, it has to be Medicare coverage for prescription drugs. And whenever that happens, there's going to be a price negotiation that takes place with the federal government and the pharmaceutical manufacturers. And that's what they're fighting. That's what they spend $78 million a year lobbying Congress to stop. We can't be the most well-developed nation in the world with the best health care system with have a $1 trillion surplus and continue to ignore the solution that's right in front of us. So I think that's exactly what Congress has to do, and it's not likely to happen before the elections because everybody's hoping that their side wins and that they don't have to compromise with the other side's plan.
Frankly, we in the states, we're not doing it to attract attention. We're just doing it because the problem's been on our shoulders and we would love to see the federal government take on the problem and resolve it for us.