Overview

States are wielding their purchasing through Rx Plus. Under Maine Rx Plus, the state serves as pharmaceutical benefit manager for residents without prescription drug insurance who have incomes up to 350 percent of the federal poverty level. The state uses its purchasing power (based on negotiating Medicaid prices) with pharmaceutical companies to obtain discounts they extend to the uninsured. It negotiates discounts in the form of manufacturer rebates, which are distributed to participating pharmacies that pass on the savings to Maine Rx Plus card holders. Enrollees are expected to save 15 percent on brand name drugs and up to 60 percent on generic drugs on the state's Medicaid Preferred Drug List. Implementation is being phased in and enrollment could reach up to 270,000 members; there are approximately 100,000 members as of July 2004.

Maine Rx Plus survived legal challenges by the pharmaceutical industry, and began in January 2004. Hawaii has developed a similar program called Hawaii Rx Plus. In July 2004, Hawaii implemented the Hawaii Rx Plus program to provide discounted pharmaceuticals to residents who do not qualify for Medicaid, have an income below 350% of the federal poverty line, and have no other drug coverage. An estimated 300,000 individuals qualify for the program, with nearly half that number enrolled as of April 2005. Enrollment was 147,467 as of April 2005. Enrollees receive a discount card to use at participating pharmacies, which allows them to pay the same prices that the State of Hawaii pays for drugs in their Medicaid program.

The program also covers pharmaceuticals that are not part of the Medicaid Preferred Drug List, including cancer and mental health drugs. Currently, 138 out of the state's 161 pharmacies participate. During this first phase, enrollees on average save 21% on pharmaceutical costs. The second phase of the program will begin in July 2005. The state will negotiate additional rebates with pharmaceutical companies on behalf of members and seek to expand the list of discounted drugs. The state hopes to have additional enrollees by July, and thus greater negotiating power. Eventually, program administrators want to save enrollees up to 60% off their out-of-pocket drug costs.

For More Information:

Web sites: www.maine.gov/dhs/mainerx www.hawaiirxplus.com Contact: Tracy H. Okubo, Hawaii Rx Plus Program Coordinator, (808) 586-5036, tracy.h.okubo@hawaii.gov