After reading your editorial about negotiating prescription drug prices (“Our View: Federal prescription plan has been on Maine’s agenda for years,” Nov. 8), I felt compelled to set the record straight about Maine Rx.

I was the House Republican leader when then-Gov. Angus King called me to his office to help write the content of Maine Rx. Being a pharmacist, I knew the ins and outs of the drug distribution system from top to bottom. The original Maine Rx as written had too many flaws to make it workable and Gov. King asked me to repair it. I did so reluctantly, knowing that Republicans would never get credit for saving the bill and making it work. It has nothing to do with negotiating drug prices. It allows low- to moderate-income people to take advantage of pricing at the pharmacy afforded to many others through their health plan coverage.

I know many people think that negotiating with pharmaceutical companies is the answer to lowering drug prices I can assure you that the countries that do that have lower costs for those medications, but the ones that may be truly life-saving brand-name drugs are excluded and accessible only if you have the money to pay for them. The negotiated drugs are put on a formulary, and they represent the class of drugs that would be covered. Any drug not on the formulary is either unavailable or can be obtained only by a cash-paying customer. I have witnessed Canadians coming to Maine to get drugs that were unavailable in Canada. I also remember those bus trips to Canada, and they were more political than real. That’s not what we need here in the United States.

We need affordable prices for every single drug out there. What we really need to be looking at is the abusive practices of pharmacy benefit managers. These entities supposedly negotiate pricing for health plans. In reality, they negotiate for their own benefit. They use things like spread pricing and rebates for themselves without passing on the real savings to the consumers paying the bill. “Spread pricing” refers to pharmacy benefit managers reimbursing pharmacies at one cost and charging more to the health plan and keeping the difference themselves. When they negotiate for rebates for drugs, they keep a large portion for themselves while sharing only a portion with the health plan that is actually paying for the drugs. Pharmacy benefit managers also punish retail pharmacies by reimbursing them below cost for certain drugs. It is why you have seen so many community pharmacies close. Those pharmacies were the heart of many communities where many people in rural areas visited to get medical advice or directed for more advanced care.

Many states have passed legislation to curb the abusive practices of pharmacy benefit managers. Maine has not, and it should be something to consider. The pharmacy benefit manager industry challenged the Arkansas law that regulated them, and the case (Rutledge v. Pharmaceutical Care Management Association) went all the way to the Supreme Court, which upheld the law. States can curb these abusive practices by pharmaceutical benefit managers if they had the will, instead of looking for a federal solution. In Maine, close to 95 percent of prescriptions are covered by a third-party payer. A lot of these plans have very high deductibles and affect many seniors who are the highest users of prescription drugs. 

It has been estimated that curbing pharmaceutical benefit managers’ abusive practices can save billions of dollars for the consumers of prescription drugs. I would suggest that is a more reasonable approach and a sure-fired way to actually save money for users of prescription drugs. As someone with close to 44 years’ experience in the pharmacy world, I am open to speaking to anyone about how it can work.

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