ElderWeb

Medicare beneficiaries in Maine have been dealt a "one two" punch by insurance companies. First they lost their only Medicare HMO, and now they are facing 25% increases in premiums for the Medigap policies they'll need when they return to the regular Medicare program.

The last Medicare HMO available in Maine, Aetna U.S. Healthcare, will no longer participate in the Medicare program and has announced that participants in their plan will no longer have coverage effective January 1. Since there are no other Medicare HMOs left in the state, all Medicare beneficiaries in Maine will have to rely on the standard Medicare program for coverage. Those who want to protect themselves against the significant deductibles and co-insurance in the standard Medicare plan will probably want to find a private MediGap insurance policy (also called a Medicare Supplement policy). Now it appears the state's residents may be in for another shock, since insurance companies that provide these policies have requested steep increases in their Medigap premiums effective January 1. Anthem Blue Cross is requesting an average rate increase of 13.5% and Banker's Life is requesting increases ranging from 7.5% to 30% on their Medicare supplement plans effective January 1, 2001. The Maine Department of Insurance reports that the average increase requested for Maine policies is 25.6%. The Department of Insurance is reviewing these requests, and must approve them before they would become effective.

The Maine Bureau of Elder and Adult Services (BEAS) conducted a survey of drug prices in Maine pharmacies, and have made the results of that survey available on the Internet. In addition, they have created an online "Drug Pricing Calculator" which allows consumers to indicate specific combinations of drugs they may need, and the area of the state where they are located. The tool shows the total cost of the drug combinations they selected from each pharmacy in their area.

The governors of New Hampshire, Vermont, and Maine announced that they have created a multi-state pool for the purchase of prescription drugs. The purchasing pool will include the Medicaid populations from all three states, about 330,000 people. By working together to focus on quality and management efficiency, the three states hope to save an estimated 10% to 15% on their prescription drug programs. The benefits of the combined purchasing pool will be available on a voluntary basis to other groups, including uninsured individuals, and businesses. They released a request for proposals, seeking bids from pharmacy benefits management companies to operate the purchasing pool.

The Pharmaceutical Research and Manufacturers of America (PhRMA) has sued the state of Maine, challenging the state's prescription drug-pricing law as unconstitutional and an abuse of fair trade practices. PhRMA filed the suit in US District Court in Maine seeking a preliminary injunction to prevent Maine officials from implementing the law until the court has ruled on the matter.

The Maine Rx program enables the state to extract rebates and discounts from drugmakers on behalf of residents who have no prescription drug benefits, by acting as the benefits manager, negotiating rebates and pharmacy discounts that will be used to lower drug prices.

Individual drug manufacturers are taking their own steps. SmithKline Beecham decided to "reconfigure" its relationship with drug wholesalers that service Maine drug retailers, by using wholesalers not based within the state, because the Maine prescription drug law is "vague and difficult to interpret."