Health Policy Report Rounds Up Recent State Legislative Action on Prescription Drug Proposals

A number of state legislatures are weighing proposals to assist seniors and the uninsured with prescription drugs costs. Measures under consideration in 19 states are summarized below as reported by local press.

• Arizona: The state House approved a bill (HB 2607) that would spend about $9 million over two years to provide drug coverage for rural seniors who earn less than 250% of the federal poverty level -- or an annual income of less than $29,025 per couple -- and spend at least $2,000 annually on drugs. Under the proposal, the state would pay half of any additional drug costs over $2,000 for eligible seniors (AP/Arizona Republic, 3/14).
• Connecticut: Democratic lawmakers are supporting a proposal to expand ConnPACE, the state's prescription drug program for the elderly and people with disabilities, to cover seniors up to 200% of the federal poverty level, or an annual income of $17,180 for an individual. The current eligibility limit is 180% FPL, or $15,462 (AP/Hartford Courant, 3/15).
• Florida: Under a bill approved March 6 by the state Senate Banking and Insurance Committee, five prescription drugs would lose exemption from a state law that requires pharmacists to dispenses the "cheapest version" of a drug unless the brand name drug is specifically requested by the physician or patient. Currently, 11 drugs are exempt from the requirement (Ulferts, St. Petersburg Times, 3/7).
• Maine: Legislators have proposed more than a dozen bills to lower drug prices for the uninsured. Proposals directed at drug companies included requiring manufacturers to disclose all costs and notify consumers if they participate in the state's drug program, Maine Rx, which is currently being challenged in court by the Pharmaceutical Research and Manufacturers of America (PhRMA). Other measures would allow the state to act as a "benefits manager" to obtain price breaks, create an 800 number to notify consumers of discount programs and have the Department of Human Services prepare a plan to reimport drug with price controls once such a plan was approved at the federal level (O'D. Moore, Bangor Daily News, 3/13).
• Massachusetts: State officials feel "confident" that the Prescription Advantage program, an insurance option open to seniors and some people with disabilities, will be operational by April 1. About 8,000 people have signed up for the program, which replaces a state subsidy available only to low-income individuals. Premiums, which can reach $82 per month, are based on the participants' income. The state has budgeted $109 million for the program, but actual costs will depend on the number of people enrolled and the severity of their prescription needs (Powell, Boston Herald, 3/16).
• Minnesota: The state Senate is considering two bills that would force price cuts and allow the uninsured to buy drugs at discounted prices. One bill would require drug manufacturers who provide discounts to public health plans to offer the "same break" to uninsured patients. The other bill would require pharmacies to offer Medicare patients the same discount offered to those in "public medical assistance plans" (O'Conner, St. Paul Pioneer Press, 3/15).
• Missouri: The state Senate Appropriations Committee approved a proposal from Gov. Bob Holden (D) to restore $127 million of the state's share of the national tobacco settlement to fund a prescription drug tax credit. The funds were removed last month to cover "emergency expenses" from the last fiscal year. The House, however, is backing a proposal to fund the tax credits with money earmarked for construction at state universities. The AP/St. Louis Post-Dispatch reports that the proposals will be "resolved by negotiators from each chamber" (Lieb, AP/St. Louis Post-Dispatch, 3/7).
• Montana: State Rep. Brad Newman (D) is urging the House Appropriations Committee to approve HB 595, which would require the state to act as a "prescription drug benefits manager" for 220,000 un- or underinsured people. The measure would also require pharmaceutical firms to provide volume-related discounts to the state similar to those provided to the Medicaid program. The program is estimated to cost more than $16 million over the next two years (McLaughlin, Billings Gazette, 3/15).
• Nebraska: A bill before the state Legislature would assist retired state workers with at least five years of service by paying for half the cost of Medicare supplemental insurance that covers prescription drugs (Lincoln Journal-Star, 3/2). Under LB 379, the Nebraska State Insurance Program would offer the supplemental coverage (LB 379 text).
• Nevada: The state Senate last week unanimously approved a bill that would increase the subsidy given to participants in Senior Rx, the state's prescription drug program for seniors. SB 239 would require the state to pay the entire $74.76 monthly premium for seniors earning less than $12,700 per year; the state currently provides these seniors with a $40 monthly premium subsidy. The legislation also recommends that the state develop more than one policy for coverage of those over 62 years of age who earn less than $21,500 annually. The program, which also requires prescription copays, took effect Jan. 1 and has enrolled only about 200 participants, although 1,900 applications are being processed (AP/Las Vegas Sun, 3/19).
• New Hampshire: The state House is considering a bill (HB 540) that would levy a 3% fee on gross sales of any prescription benefit management firm in the state (Hastings, Manchester Union Leader, 3/13). Proceeds from the fee would be placed into a fund to provide prescription drugs for low-income patients and the uninsured (HB 540 text).
• New Mexico: State lawmakers have acted on a variety of proposals. The state House and state Senate have passed legislation to inform seniors how to purchase discounted drugs from Canada. In addition, the Senate passed a measure to spend $1 million to allow low-income seniors not eligible for Medicaid to purchase drugs at the same prices Medicaid pays. However, a measure that would have required drug companies that offer discounts to HMOs, hospitals and mail-order pharmacies to extend the same discounts to community pharmacies was recently defeated in the state Legislature (Cole, Albuquerque Journal, 3/11).
• Northwestern states: Lawmakers from several states are working together to negotiate better prescription drug prices. The Idaho House and a Senate committee have passed HCR 26, which would allow the governor and the Health Department to form a "coalition with sister states to develop a compact to purchase prescription drugs at economic rates" (HCR 26 text). In Washington, the state Senate unaminously passed SJM 8001, which calls for cooperation between Idaho, Oregon, Alaska and Montana to reach deals with pharmaceutical companies and "pass the savings on to consumers" (Russell, Spokane Spokesman-Review, 3/10).
• South Carolina: House Republicans have "pieced together" a prescription drug plan that would cover drugs with a $100 deductible and a $15 copayment for each brand name prescription or a $5 copay for each generic prescription. Called SilverCard Plus, the program is based on the state's existing SilverCard program, which is open to seniors who have incomes between $11,251 and $19,687 for couples and from $8,531 to $14,612 for individuals, and who have lived in the state for at least six months. The existing program requires a $500 deductible, and copays of $21 for brand name drugs and $10 for generics. State Republicans are considering seeking a federal waiver in order to use Medicaid funds for the SilverCard Plus program (Wise, Charleston Post and Courier, 3/14).
• Tennessee: State legislators are considering a program to provide the elderly and people with disabilities a 15% to 25% discount on drug prices. For a $25 annual fee, enrollees would receive a prescription card good for discounts that TennCare, the state's Medicaid managed care program, would negotiate with pharmaceutical companies. Only seniors and people with disabilities who do not have drug coverage would be eligible for the program (Cruz, Nashville Tennessean, 3/8). TennCare officials, however, oppose the plan because the legislation would bar pharmaceutical firms that do not enter the program from participating in TennCare (Ferrar, Knoxville News-Sentinel/MemphisCommercial Appeal, 3/8).