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[e-drug] Maine considers new rx bills (3 stories)

E-drug: Maine considers new rx bills (3 stories)
Warning:  very long message

Expanding access to prescription drugs is not only an issue in developing
countries.  In the US, during our presidential election campaign last year,
access to prescription drugs by the elderly was an important campaign
issue.  As campaign promises fade from attention under our new
administration, state governments are becoming increasingly
involved.  Maine, one of the most progressive states on this issue, is
leading efforts to pressure the pharmaceutical industry to lower drug
prices for those without insurance coverage (see attached stories).  In
recent years, state governments were also in the forefront on 
successful efforts to require tobacco company reparations for smoking 
induced illness.  Time -- and our legal system -- will tell if states 
are able to make progress on the issue of access to medicines as well.

Dennis Ross-Degnan, ScD
Associate Professor
Drug Policy Research Group
Dept. of Ambulatory Care & Prevention
Harvard Medical School
126 Brookline Avenue, Suite 200
Boston, MA 02215  USA
Tel: +1 617-421-2631            Fax: +1 617-859-8112
E-mail: drossdeg@hms.harvard.edu
Bangor [Maine] News
Tuesday, March 13, 2001

Mainers back bills to cut costs of medicine
By Michael O'D. Moore, Of the NEWS Staff

AUGUSTA ? With the first battle between the pharmaceutical industry 
and state lawmakers tied up in court, a spate of new prescription 
drug bills promises to open new fronts in what some are calling 
Maine's drug war.

More than a dozen bills aimed at lowering drug prices for the 
uninsured and finding out what pharmaceutical companies spend on 
advertising landed before the Legislature's Health and Human Services 
Committee on Monday.

Many of those testifying in favor of the bills also fought for passage of
Maine's Rx Program last year, which is being challenged in court by the
Pharmaceutical Research and Manufacturers Association. They expressed 
outrage that the companies won't cooperate in lowering prices for the 

"As far as I'm concerned we're in something of a war," said John 
Marvin, director of Region 1 (the New England states) for the 
National Council of Senior Citizens. "It's a war that involves the 
people who are least able to afford prescription drugs [the 
uninsured]... these are the people who are being called upon to pay 
the highest price for prescription drugs."

Marvin was a key supporter of the Maine Rx Program, which would 
require drug manufacturers to negotiate discounts for the uninsured 
or face price controls. The law also includes provisions to use 
profiteering laws against companies that refuse to participate.

Several proponents said the new bills are necessary because the
pharmaceutical industry would rather fight than cooperate with 
efforts that might bite into profit margins averaging more than 20 

"If panic and concern for profits had not interfered you would not have
these bills before you today," said John Moran, president of The Maine
Council of Senior Citizens. He criticized pharmaceutical contentions that
price cuts would endanger research for new drugs. "No matter how you 
slice their argument, it's baloney," Moran said.

Among the bills are proposals to:
* Require disclosure of pharmaceutical manufacturer costs, including 
direct advertising.
* Require stickers on prescriptions to tell consumers whether the
manufacturer cooperates with Maine's Rx Program.
* Empower the state to act as a pharmacy benefits manager, similar to 
an HMO, to gain price breaks for the uninsured.
* Create an 800 number to direct Mainers to relevant discount 
programs run by drug manufacturers. Application assistance also could 
be offered.
* Direct the Department of Human Services to prepare for 
reimportation of drugs from countries with price controls once 
approved at the federal level.
* Expand the state's Elderly Low-Cost Drug Program to cover more 
Mainers and more prescription drugs.

Attesting to the ongoing problems faced by Mainers without prescription
coverage, several residents told about the high drug prices they must 
pay. As with hearings on the Maine Rx Program last year, senior 
citizens and others described dire circumstances that force a choice 
between necessary drugs and other expenses such as food and heat.

Legislators said prescription prices are a top priority of constituents.

"I know on the campaign trail every other house and every other door I
knocked on raised these issues," said Rep. Patrick Colwell, D-Gardiner.
Colwell is sponsor of the bill to identify drug manufacturers that don't
voluntarily cooperate with Maine's Rx Program, which aims to get 
drugs to the uninsured at or near the discount price achieved through 
the Medicaid program.

"This bill simply empowers consumers to vote with their pocketbooks," he said.

Many proponents said that with prescription drug prices rising 
rapidly, they wanted to get information on the amount of money spent 
by drug companies on advertising in relation to research and 

"I believe the industry is spending at least as much if not more on
advertising than research and development," said Sen. Sharon Treat,

Treat held up a Sunday New York Times Magazine to illustrate an 
expensive advertisement for a drug. "This is very big dollars to 
advertise like this," she said.

In 1993, the Federal Drug Administration cleared the way for drug 
companies to advertise their products directly to consumers. Drug 
companies say the advertising educates consumers.

Ann Robinson, an Augusta-based attorney representing the 
Pharmaceutical Research and Manufacturers Association, said 
advertising helps empower consumers by giving them information.

PhRMA agrees, and like some who testified, the organization favors
empowering consumers. She said advertising is a form of education.

One of just a few who testified against the majority of the proposals,
Robinson said that the FDA already oversees the content, form and 
emphasis of advertising before it can be presented to the public.

PhRMA also believes the state shouldn't put itself in the role of being a
Prescription Benefit Manager. She said just as the state restricts what
drugs Medicaid patients get, PhRMA worries the same sort of 
restrictions would be at play if the state became a benefits manager 
for the uninsured.

Robert Morrissette, president of the Pharmacy Group of New England, 
argued against the state preparing for reimportation of drugs when it 
doesn't even know what the rules would be.

And, he said the state shouldn't enter the pharmacy benefits manager
business in competition with private-sector businesses.

Although he was absent, written testimony from Dr. Erik Steele of 
Eastern Maine Medical Center was entered into the record, which 
describes the variety of free trips, trinkets and other items offered 
by drug companies to entice doctors to prescribe their products. Such 
promotions are paid out of the profits from drug sales, he argues.

Not everyone testifying took sides. Tom Federle, an attorney 
representing Bindley Western, a Westbrook-based drug distributor, 
asked legislators to understand the distinct roles of manufacturers 
and distributors and clarify legislation accordingly.

If drug prices have become a "war," drug distributors are "caught in the
cross fire," Federle said.

Distributors don't set prices and do no marketing and advertising. No one
will find any pens with "Bindley Western" printed on them lying around
doctors' offices, he said.

"We are not acting as an agent of the manufacturers," Federle said.

After the meeting, veteran Health and Human Services Committee member 
Rep. Elaine Fuller, D-Manchester, said she thinks both Democrats and 
Republicans are interested in finding new ways to help the uninsured 
get prescriptions.

She called the spate of bills "more creative and innovative" than in past
sessions. "I would hope that out of all of this there is some 
progress in addressing the problems," she said.

"We're not here to demonize an industry," Rep. Colwell said during his
remarks. "We're not here to pick good guys and bad guys. We're here 
to give the citizens of the state of Maine an even shot [at 
affordable drugs]."

Tuesday, March 13, 2001
State takes new steps to cut drug costs

By GREGORY KESICH, Portland Press Herald Writer
Copyright © 2001 Blethen Maine Newspapers Inc.

AUGUSTA ? A year ago, Maine became the only state in the nation to 
enact a law controlling prescription-drug prices. On Monday, work 
began on a package of new bills that lawmakers say would maintain 
Maine's leadership on the issue.

Members of the Health and Human Services Committee heard a wide range 
of proposals, including one to legalize the importation of 
prescription drugs from Canada, where the same products sell for a 
fraction of their U.S. prices. Other bills would: Require 
pharmaceutical companies to reveal how much they spend to advertise 
and market their medications.
Require pharmaceutical companies that won't negotiate prices for their
products through Maine's landmark Rx Program to acknowledge their 
refusal with a sticker on every prescription they sell here.
Create a state pharmacy benefits manager, who would buy drugs for 
residents in bulk the way private insurers do.

"The cost of providing prescription drugs increased dramatically over 
the past year, (which is) the continuation of a trend," said Sen. 
Sharon Treat, D-Gardiner, a sponsor of one of the bills.
"Prescription-drug costs are a major factor in the increase in 
health-care costs in Maine."

None of the new proposals is as ambitious or sweeping as the Maine Rx
Program. The law signed by Gov. Angus King last year threatens the 
industry with price controls if the companies fail to negotiate 
dramatically lower prices for the 350,000 state residents who have no 
prescription-drug coverage.

On the day the law was to go into effect, the companies sued the 
state. With the case now under review by the U.S. Court of Appeals, 
supporters of the price-control approach are trying to maintain 
momentum on the issue, which they say remains a top priority in their 

"These bills are an extension and refinement on the major 
groundbreaking bills of the last session," said Rep. Thomas Kane, 
D-Saco, a co-chairman of the committee. "Maine Rx is the centerpiece 
and we want to reinforce that. .. . Our goal at this point is to do 
no harm."

There is another difference between this year and last, said Rep. Robert
Nutting, R-Oakland, who is a druggist and an opponent of the Maine Rx
Program. "Last year was an election year, and this isn't," he said. 
"When the election is over, there's always an attempt to inflict some 
hurt on the people who didn't play ball."

At Monday's public hearing, supporters of the bills said prescription 
drugs are driving up the cost of health insurance and municipal and 
budgets. They also said people are being forced to make difficult choices,
such as whether to pay for their medications or for food or heating.
Two women said they used credit cards to pay for their prescriptions,
running up huge debts they can't repay.

An Old Orchard Beach woman said her husband has considered divorce, 
so she would qualify for a state-run low-income prescription 
assistance program.  Jocelyn Plourde, 50, has diabetes, multiple 
sclerosis and heart disease, and her husband has severe arthritis and 
broke his back three years ago. Between them, they need 20 
medications that cost
$1,000 a month, but their combined disability-insurance benefits are 
too high to allow them to get help from the state.

"There is something wrong with a government that would force someone 
to annul something as sacred as marriage," she said.

Plourde spoke in favor of the new bills, but said none of them would help
her personally. "All of them will be helpful for some people," she 
said. "It will take time."

It was unclear Monday how much some of the new bills would help 
reduce costs for anyone. For instance, even if the Legislature 
approves the bill to import drugs from Canada, implementation would 
be blocked by a recent federal ruling.

Late last year, Congress enacted a law allowing reimportation of 
drugs sent to Canada by U.S. manufacturers. But before it could go 
into effect, Donna Shalala, then secretary of Health and Human 
Services, said the government would not go forward with the plan. She 
said the drugs would take too long to reach American consumers and 
the government could not guarantee their safety.

The Bush administration has not announced its position on the issue.

Rep. David Lemoine, D-Old Orchard Beach, said his bill would 
authorize Maine to get involved in drug reimportation if the federal 
policy is changed.

The two bills requiring disclosure of marketing and advertising costs 
would not have a direct effect on drug prices. But Kane said they 
could have an impact in the long run because they would prove that 
the high cost of drugs is driven less by scientific research and 
development than by high-tech television ads and free trips and gifts 
for doctors.

Bills that have a cost attached - such as one to increase the number of
people who can enter the Elderly Low-Cost Drug Program and another to 
add medications to the list of subsidized drugs - may have trouble 
support while the budget has a $290 million shortfall.

Legislators and activists on both sides said the most important decision
concerning Maine's prescription-drug costs may be made in the federal 
courts this year and not in the State House.
"If the (Maine Rx) bill doesn't go forward, " Nutting predicted, "all these
other bills are irrelevant."

Staff Writer Gregory Kesich can be contacted at 623-1031 or at:


Witnesses urge lower drug prices
By Bonnie Washuk

Staff Writer

The pharmaceutical industry came under heavy fire Monday as dozens of
residents asked lawmakers to do something to help Mainers afford their

John Moran, president of the Maine Council of Senior Citizens, 
testified his organization supports all of the 15 bills before the 
legislative Health and Human Services Committee. Drug companies are 
spending too much on marketing, which is inflating costs, he said.

He said in 1999, USA Today reported that $93 million was spent to 
advertise one drug: Viagra.

"We will hear today that these bills before you will cause the drug
manufacturers to reduce their research, preventing them from bringing 
to market new prescription drugs," Moran said. "You will hear that 
profits will be so reduced, they will be destabilized as an industry.
Baloney! Baloney! No matter how you slice their arguments, it's baloney!"

Taxpayers help pay for research and development while getting socked 
with the highest prices in the world, he said. "We need to send a 
strong message to the drug manufacturers that we are fed up, and 
we're not going to take it anymore."

John Marvin of the council said the drug industry has been fighting the
state in court, and "we're in something of a war. It's a war that involves
the people who are least able to pay for drugs," seniors without drug

"These are the people being called on to pay the highest drug prices in the
world to support the most profitable industry," Marvin said.

Tearful testimony

A soft-spoken and tearful Wilma Dow, 56, of Lewiston, told lawmakers 
it's not just seniors who are struggling, it's people like her.

A former nurse's aide who worked for the state with mentally ill 
patients, Dow now lives on workers compensation after becoming 
injured. Before winning her workers comp claim, she said she lost her 
home and went into debt.

She is trying to get out of debt, but with her prescription costs it is
nearly impossible. Dow told lawmakers she suffers from fibromyalgia, 
back and neck damage, and endures pain all of the time.

She should be taking three prescriptions, but they cost $231 a month. 
That, she said, would take one-fourth of her income - a week's worth 
of her $230 check - leaving $690 a month for food and rent.

Dow begged lawmakers to do what they could to lower drug costs. "It's
devastating not just for the elderly but other people," she said, 
losing her battle to fight back tears.

Using a cane to help her walk, Charlotte Walton of Lisbon told 
lawmakers she goes without medicine she needs because if she took 
what her doctor
recommended, "I'd have to sell my home and move into low-income 
housing. I only have money enough to buy medication for my heart and 
my diabetes."

William Layman, who chairs the York County Commission, said he's lucky
because his retirement benefits include prescription coverage.

'A disgrace'

"But I know very well those who have to decide whether they're going 
to eat or get their drugs," Layman said. "It's a damn shame that we 
live in the biggest, greatest country in the world - and I served in 
World War II and Korea - that doesn't have universal health care and 
universal prescription drugs. It's a disgrace.

"Please make Maine the first state in the nation to move forward," he 
told lawmakers.

Anne Robinson, lobbyist for the Pharmaceutical Research and 
Manufacturers of America, said the Food and Drug Administration 
regulates the ads, and consumers like them. The bills would have the 
industry do what it asks of no other industry, disclose marketing 
costs, she said.

Underlying the legislation is a premise that advertising is bad, Robinson
said. "Rep. Colwell said this morning that public awareness empowers
consumers." PhRMA agrees, she said. The ads help people become more 
involved in their health care and work with their doctors to find 
health care options, she said.

Committee member Rep. Marie Laverdiere-Boucher, D-Biddeford, asked 
her, "What is the industry doing to keep costs down?"

Robinson said manufacturers give drugs to some who cannot afford 
them, and the industry gives states like Maine rebates for high 
volumes of drugs purchased through the Low-Cost Drugs to the Elderly 
and Medicaid programs.

The committee is scheduled to take up the bills at 1:30 p.m. Friday at the
State House.

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