Medicare elders/disabled eligible for discount prices based on Medicaid rates

AZ, CA CT, CO, FL, MA, MD, ME, MN, MO, NH, OH, RI, VT, WA, WI,

Seniors eligible for discount prices based on "Federal Supply Schedule"

AZ, IL, PA, VT

Broader public use of Federal Health Centers
(FQHCs obtain prescription drugs at discounts similar to the best Medicaid rebate rates)

CT, RI, VT

State bulk purchasing to achieve greater price discounts for all eligible groups

AZ, CA, FL, MA ME, NH, NY, OR, RI, VT, WA,

State "buyer's clubs" (non-legislative, via Governors' offices)

IA, ME, NH, VT, WA, WV (executive initiatives)

State coordination of pharmaceutical industry free/charity programs

Advertising costs disclosed to the state

PA

Price controls or state maximum prices.

AZ, CA, CT, ME, MI, NJ, NY, OH, PA, VT

Would create a Prescription Drug Fair Pricing Board which "shall establish the maximum price for prescription drugs", based upon:
1. "The maximum price for a prescription drug sold in this state by a Manufacturer shall be the lower of the price listed in either: (a) the federal supply schedule for pharmaceuticals and drugs maintained by the United States Department of Veterans Affairs. (b) the drug formulary maintained by the Canadian province of Quebec.
2. The maximum price for a prescription drug sold in this state by a wholesaler is the maximum manufacturer price as determined pursuant to paragraph one plus any usual and customary wholesale markup." Includes an appeal procedure for manufacturers, but provides that appeals do not delay implementation of maximum price.
(Filed 2/8/2000; did not pass by end of session, 4/18/2000)

Senate amended version, §10 and §11, would create a discount purchasing program through Arizona Health Care Cost Containment System (AHCCCS). Allocates $185,000. Based on SB 1270 and SB 1271, below.
(Passed Senate with amendment; did not pass by end of session, 4/18/2000)

Would establish a prescription medications purchasing program to provide access to medications at the lowest market rate to individuals age 60 and older. Would require the Arizona Health Care Cost Containment System (AHCCCS - the state's Medicaid waiver program) contract with at least two pharmaceutical benefits management (PBM) companies to administer the program. Would authorize the PBM to allow participants to purchase prescriptions through the mail or a pharmacy network. Contains a $185,000 appropriation.
(Filed 1/18/2000; sent to caucuses; did not pass by end of session, 4/18/2000)

Would require the Medicaid (AHCCCS) administration to provide prescription medication coverage to certain Medicare beneficiaries. Contains a $10,000,000 appropriation. Also would authorize a proposed amendment to 1115 waiver to include prescription medications to qualifying Medicare beneficiaries.
(Filed 1/18/2000; did not pass by end of session, 4/18/2000 )

Would require the state to design a program for bulk or aggregate purchasing of prescription drugs for Medicaid and Medicare beneficiaries, "members of the Public Employees' Retirement System, uninsured and underinsured persons 65 years of age and older, and for other individuals for whom the state subsidizes the purchase of prescription drugs." The results of the study, along with a program proposal are to be submitted to the Legislature by January 1, 2002; statutory approval is required prior to implementation.
(Amended; passed Senate & Assembly, 8/29/2000; Vetoed, 9/28/2000)

Pharmaceutical advertisements. This non-binding resolution would memorialize the Food and Drug Administration to reverse its decision allowing pharmaceutical companies to advertise their products to the public. Bill analysis
(Amended, adopted by Senate; Assembly Health Committee failed to pass 8/8/2000)

Would require pharmacies that provide medications to Medicaid to offer medicines to Medicare enrollees at the Medicaid reimbursement (discount) rate, plus transfer fee. Would require department to report on pharmacies that drop out of Medicaid program. Exempts DSH (disproportionate share hospitals) hospital pharmacies. Amended version provides for state payment for losses incurred by retail pharmacies.
(Read 2^nd time in Senate and amended; Appropriations Committee report; did not pass as of adjournment, 5/3/2000)

Resolution would establish an executive agency study to evaluate the feasibility of offering Medicare recipients under 185 percent of poverty prescriptions at the Medicaid reimbursement rate; study to be completed by June 30, 2000.
(Passed House, 4/14/2000; did not pass Senate as of adjournment, 5/3/2000)

Would provide that no manufacturer or wholesaler of prescription, or legend, drugs, may charge a price for such drug that is greater than the price charged in any other state or foreign jurisdiction.
(Reported favorably from Aging Comm. to Human Services Comm, 3/6/2000; did not pass as of end of session, 5/3/2000)

To allow Medicare patients to purchase prescription drugs at the Medicaid rate when they are paying for such drugs out of pocket.
(S.246; sent from Aging Comm. to Human Services Comm, 3/6/2000;
H.5736 amended; held in Public Health Committee; did not pass as of end of session, 5/3/2000)

Would create wholesale or aggregate buying consortium with Medicaid clients and state employees; also study commission; Appropriates $15 million for Pharmacy Benefit subsidy program; would seek federal waiver for possible federal funding.
Amended version would establish a "medication purchasing cooperative to assist qualified individuals with the purchase of prescribed drugs at the best possible price."
(Amended and passed House, 119y-0n, 5/2/2000; did not pass Senate, 5/5/2000)

Senior Citizen Prescription Drug Discount Program Act.
Would require the Department of Revenue to establish and administer a program to enable eligible senior citizens to purchase prescription drugs at discounted prices. Must be over 65 and pay an $25 annual enrollment fee. Prescription drug prices for eligible seniors at authorized pharmacies could not exceed prices listed on the Federal Supply Schedule plus a dispensing fee. The bill would not preclude any authorized pharmacy from charging less than the listed price on the Federal Supply Schedule. In addition to a dispensing fee, authorized pharmacies would be entitled to Compensation equal to the Average Wholesale Price (AWP) minus 10 percent for Pharmaceutical products covered.
(H3036 amended and passed House, 3/1/2000; did not pass Senate)
(S1403 Filed 1/20/2000; did no pass)
NOTE: In May 2000, HB 3872 of 2000 raised income levels for the senior pharmacy assistance program to $28,480 for a couple.

On Sept 18, 2000 Gov. Vilsack and U.S. Senator Tom Harkin announced the proposed establishment of a state prescription drug purchasing co-operative, or "buyer's club". For an annual fee of $15 to $30, senior citizens would be eligible to purchase pharmaceuticals at a discount rate. (Program description on-line)
(Initial funding via a $1 million federal grant, contained in U.S. Senate legislation)

Would create a program to "obtain the best prices and widest coverage for all Massachusetts patients requiring covered outpatient prescription drugs with the least administrative and regulatory burden on manufacturers and distributors". The state would enter into an agreement with each manufacturer of a covered outpatient prescription drug to secure the largest possible discounts and rebates for these products. Also includes pharmaceutical assistance.
(Sent to interim study, 7/99; carryover to 2000; did not pass)

Would allow Medicare enrollees to receive prescription drugs at a price not to exceed the Medicaid reimbursement rate for prescription medicines. For costs to the state, see Fiscal note
(HB 1336 Environmental Matters Committee reported favorably; bills did not pass as of end of session, 4/10/2000)

Would establish the Maine Prescription Drug Fair Pricing Act, and would do the following:
Establish the Fair Drug Pricing Board. The board, with the approval of the Legislature, sets the maximum prices for prescription drugs based upon a specific formula. ... The board may enter into agreements with other states or Canadian provinces to ensure uniform prices for prescription
Expands prohibition against profiteering in necessities to include prescription drugs.
(Reported ought not to pass, 3/29/2000)
see S1026 above

Would require the department to form or enter into a prescription drug purchasing consortium, to enable the department to obtain prescription drugs at the most favorable and competitive prices available from the manufacturers of prescription drugs. The department would establish the Prescription Drug Distribution Program, to provide for the sale of the drugs to consumers.
1. Purchase of prescription drugs. The department would utilize the consortium to purchase prescription drugs and make them available to consumers, to the extent allowed by the funds appropriated to the program, at the lowest possible cost through the program.
2. Sale of prescription drugs. The department would contract with cooperating pharmacies and hospitals to sell prescription drugs to consumers at prices to be set by rule adopted by the department.
(Committee reported ought not to pass; report accepted 3/23/1999)

Would create the "pharMIgap" program to give every Michigan citizen age 60 and older a 50-percent discount on their out-of-pocket cost for prescription drugs. Provides that the State negotiates a bulk-purchasing discount directly with pharmaceutical companies on behalf of Michigan's 1.3 million uninsured people. The State's volume discount will be in the form of a manufacturer's rebate from the pharmaceutical company. Uninsured persons will be provided with a state insurance card they can show at the pharmacy counter to receive the state-negotiated price. The State's discount does not lower the wholesale cost of purchasing drugs by pharmacies. The pharmacies will buy their drugs at the same price as always. But the pharmacies will sell the drugs to qualified persons at the state-negotiated price. Pharmacies will submit bills to the State for the difference between what they paid the drug maker and what they charged the consumer. The State uses its manufacturer's rebate to pay the pharmacy -- in essence, it passes the rebate along to the pharmacy for each prescription sold. The State does not expend any taxpayer money on this program.
(Filed 5/23/2000; sent to the Committee on Appropriations; did not pass)

Would create the Michigan Prescription Fair Pricing Act, to:
1) Direct the state government to use its bulk purchasing power to negotiate steep discounts with pharmaceutical companies -- and pass the savings on to those with no prescription drug insurance coverage.
2) Provide a state prescription card to all residents who do not have prescription drug insurance, allowing these citizens to qualify for state-negotiated discounts.
3) Require the state to determine within three years whether negotiated drug prices are comparable to the lowest prices available in the state. If not, then the state will unilaterally set maximum prices that can be charged for certain prescription drugs.
4) Impose penalties of up to $100,000 for drug makers that "profiteer" by charging excessive prices or restricting the supply of pharmaceuticals in the state.
(Filed 6/21/2000; sent to Committee on Health Policy; did not pass)

Medicare enrollees entitled to Medicaid discounts. Would allow a pharmacy to participate in the medical assistance program as a covered provider if the pharmacy agrees to charge Medicare beneficiaries a price for prescription drugs that does not exceed the medical assistance reimbursement rate. Medicare beneficiaries must provide a valid prescription and a Medicare card.
(Filed 2/1/2000; sent to Sen. Health & Family Security Committee; did not pass as of end of session)

Requires pharmacies that participate in the Medicaid program to provide Medicare prescriptions at the Medicaid rate. Fiscal Note on-line
(Passed House, 153y-1n, 4/20/2000; did not pass Senate as of end of 2000 session, 5/12/2000)

The NH Executive Council passed a pilot program that provides discounts of up to 40 percent on generics and 15 percent on brand-name drugs. Enrollment for those over age 65 began in January, 2000
Office of Family Services, Division of Elderly and Adult Services
The Governor and Executive Council acted as follows:
#87 "Authorized to enter into an agreement with National Prescription Administrators, Inc., East Hanover, NJ, to develop and implement a two year pilot Senior Discount Prescription Drug Program at no cost to DEAS and consumers, effective date of Governor and Council approval with a termination date two years from date of such approval. All Administrative costs associated with this agreement are the responsibility of NPA."
(Approved by the Executive Council November 10, 1999)

Would establish within the Department of Health and Human Services the outpatient prescription drug cost reduction and coverage expansion program, a discount prescription drug program for people with limited incomes. The bill also establishes a fund to offset the cost of the pharmaceuticals, and an advisory council to oversee the administration of the program. Included rebate.
(Sent to 1999 Interim Study Committee; did not pass)
Note: The NH Senate has facilitated a Pilot Patient Assistance Program initiated via a private PhRMA grant, to expedite free prescription drug products through hospitals, clinics and other providers.

Lowest discount program. Would require a prescription drug manufacturer to offer a drug it manufactures or processes to any purchasers or wholesale distributors on the terms and conditions offered or accorded to the manufacturer's most favored purchaser or wholesale distributor, except for variations because of the manufacturer's actual distribution costs; volume and payment discounts, which discounts must be made available to all purchasers or wholesale distributors on equal terms; and reasonable purchaser or wholesale distributor margins.
(Held in Committee; no report as of end of 1999 session, 12/99)

A 1483
Assembly-member Rose Marie Heck

Medicaid-only price reduction. Would "ensure that the State, through the Medicaid program, pays no more than the lowest price charged in foreign countries by pharmaceutical manufacturers for outpatient drugs covered by the State program." Rebate to be based on "the difference between the average manufacturer's retail price made available to purchasers in the State and the lowest manufacturer retail price made available to purchasers in foreign countries by international wholesalers."
(Filed 1/11/2000; did not pass)

Would prohibit price discrimination. " Would require a seller to offer drugs, during the same time period, to all purchasers on the same terms and conditions whether the sale is a direct transaction between a manufacturer and a purchaser or one in which a manufacturer sells to a purchaser through a contractual arrangement implemented by one or more wholesalers."
(Originally filed as S7380 in 1994; Filed 3/1/99; did not pass)

Would mandate that the cost of pharmaceutical drugs in NY State be no more expensive than any other location where such drugs could be purchased (including federal government purchases and foreign countries); provides criminal and civil sanctions for violations.
(S6068 - Filed 1999; amended and recommitted to Senate Health Committee, 3/7/2000; did not pass)
(A9786 - Filed 3/6/2000, Assembly Health Committee; did not pass)

Would provide for the bulk purchase by the state of all pharmaceuticals used by the state or paid for by the state; provides for mandatory participation. It requires the deposit of drug rebates into a fund for the elderly pharmaceutical insurance coverage (EPIC) program; requires the commissioner of health to establish an information network on the best therapeutic and cost-effective utilization of pharmaceuticals.
(Filed 4/18/2000; sent to Senate Health Committee; did not pass)

Would create an Interstate Compact and Commission on Equitable Pricing of pharmaceutical patented and generic drugs; makes it a felony to sell pharmaceutical patented or generic drugs in any signatory state at a price which is greater than any price charged for such drug to any other person, firm, corporation, state, government, department, agency, etc. in the U.S. or any other country.
(Filed 4/18/2000; A10919 did not pass)

Would establish a discount Rx Program in the Department of Job and Family Services. Participants would include Ohio residents of any age who lack prescription drug coverage through public program or private insurance, and who apply. Those enrolled would receive an Rx program enrollment card to be presented at retail pharmacies to receive discounts on prescription drugs covered by the program. Retailers would receive a $3 fee, and manufacturers would be asked to pay a rebate comparable to Medicaid rebates. Program "may be coordinated with other programs, to enhance efficiency, reduce the cost of prescription drugs, and maximize the benefits of the Rx program and other programs". Provides that if prices for the Rx Program are not "reasonably comparable" to prices charged to others by April 2005, the department shall adopt maximum price rules. Includes civil penalties for price violations.
(Filed 6/27/2000; did not pass)

All state and public programs in Pennsylvania "shall pay a fair and reasonable price for each prescription medication covered by or paid for by that agency." Defines:
"Fair and reasonable price." The price of a medication or drug as listed on the most recent Federal Supply Schedule plus the addition of a dispensing fee. The fair and reasonable price shall include the cost of any co-payment required from the consumer of that prescription medication.
"Federal Supply Schedule." The price catalog, containing goods available for purchase by Federal agencies. Drug prices on the Federal Supply Schedule are negotiated by the United States Department of Veterans Affairs and are the best publicly available indicator of the prices drug companies charge favored customers.
"Public program." The PACE and PACENET program, Medicaid, the State Employees' Benefit Trust Fund, the State Employees' Retirement System, the Public School Employees' Retirement System and any other State agency or designated pharmaceutical program that purchases or arranges for the purchase of prescription medications."
(Filed 2/10/2000; did not pass)

Would allow pharmacies to purchase drugs for Medicare beneficiaries at the substantially reduced price available under the Federal Supply Schedule, in order to make prescription drugs available to Medicare beneficiaries at substantially reduced prices.
(Filed 1999; did not pass)

Would establish a Fair Drug Pricing Board, a 15-member body to review prescription drug prices and mandate that prices be no higher than the Federal Supply Schedule.
(Filed 5/4/2000; did not pass)

Would establish the FAIRx program, to enable Medicare-eligible residents to purchase prescription drugs at the state-funded PACE program discounted price, via any PACE participating pharmacy. Also, would pool existing state programs under a single Pharmacy benefits manager (PBM) who would be authorized to negotiate "best price" rebates with manufacturers.
(Filed 9/25/2000; did not pass)

"Disclosure" bill, would require pharmaceutical companies to disclose direct and indirect advertising costs of prescription drugs to the Pennsylvania Health Care Cost Containment Council. The Council would then compare the costs of advertising with the claimed benefits of a reduction in invasive surgery, hospital stays, etc.
(Filed 11/6/2000; did not pass)

Would establish the Rhode Island health care trust, with extensive oversight functions including , #24: To use bulk purchasing power to lower costs of the Rhode Island health care system;
(Filed 2/9/2000, Senate Corporations Comm. held for further study, 3/30/2000)

Would establish:
1. "Therapeutic and cost-effective prescription drug education and utilization system" to facilitate optional use of generic substitutes and to educate medical professionals; appropriates $750,000 to carry out the program.
2. "Temporary Emergency Pharmaceutical Assistance" - to assist residents to purchase drugs at the lowest possible cost, taking into consideration the Federal Supply Schedule price and prices in Canada.
3. Board of Pharmacy would develop procedures to facilitate purchases in Quebec.
4. Would expand and designate "Federally Qualified Health Centers" for use by broader segments of the public.
5. V-SCRIPT Senior pharmacy program buy-in for Medicare beneficiaries. Would allow persons over 151 percent of poverty to purchase prescription drugs with a 50 percent copayment plus a premium to be set by the commissioner.
6. Would create the "Prescription Drug Fairness Pricing Program" to establish a "price schedule of maximum manufacturer prices" to take effect October 1, 2001 "unless the Board determines that alternative mechanisms have been successfully implemented."
"Nothing in this act shall be construed to require any retailer or wholesaler to sell any prescription drug in Vermont at a price lower than the sum of its actual cost of purchasing the drug plus such retailer's or wholesaler's reasonable, customary cost of doing business and profit markup."
(Passed by Senate 2/29/2000; House version deleted price control provision [#6], 4/21/2000; died in Conference Committee at end of regular session, 5/16/2000)
Notes:VT newspaper analysis 5/16/2000 - "Drug bill dies in final hours..."

Would prohibit price discrimination. Would require a manufacturer to sell drugs in the state in a covered transaction to any purchaser during the same time period on the same terms and conditions offered or accorded to the most favored purchaser in this state. Terms and conditions include the following:
1. Purchase prices for similar volume purchasers.
2. Rebates, free merchandise, samples and similar trade concessions.
(Filed 1999; carried over to 2000; in Health & Welfare Committee; no action as of end of session, 5/16/2000)

"It is the purpose of this act to consolidate the purchasing power of the state of Vermont for the benefit of its citizens, and to use that purchasing power to negotiate with prescription drug manufacturers to provide the citizens of Vermont with prescription drug prices that are as low as possible and comparable to the prices drug manufacturers charge other favored customers.
§2 ... establish the Vermont prescription drug pricing and consumer protection program within the office of Vermont health access, for the purpose of negotiating the lowest possible, fair prices for prescription drugs sold at wholesale in Vermont and reducing prescription drug prices for all Vermonters. Prices negotiated by the commissioner shall be the maximum wholesale price for all prescription drugs sold in Vermont."
(Carried over to 2000, died at end of session; see redraft as S. 300)

Would create the Washington low-cost prescription drug program, including a rebate program with drug manufacturers, administered by the State Treasury.
(Sent to Health Care; no action as of end of session, 4/7/2000)

Would create a state discount prescription drug program for low-income seniors. Funded through rebate system with drug manufacturers, it allows pharmacies to sell at a discount. A related bill, SB 6600 would create a Senior Pharmacy Assistance program,
(Sent to Senate Health and LTC; no action as of end of session, 4/7/2000)

By executive action, the Governor is establishing a bulk purchasing plan for seniors age 55 or older. AWARDS (A Washington Alliance to Reduce Prescription-Drug Spending). "Starting in January 2001, residents aged 55 and older will pay $15 per individual and $25 per family each year to join what amounts to a buyer's club. Their purchases at participating pharmacies will be piggy backed on the buying power of the state Uniform Medical Plan to buy drugs at significantly lower cost. AWARDS members can expect to pay from 12 percent to 30 percent less for prescriptions than the retail price. If members order from a mail service, they can expect discounts of from 20 to 49 percent."
(Established by executive order, announced 8/29/2000; rules adopted 12/15/2000; effective date 1/15/2001) agency release, 12/18/00
(Lawsuit filed1/5/01 in state Superior Court block implementation)
(Superior Court Judge Strophy signed an order on June 22, 2001 invalidating the program)

S. 335 would create prescription drug assistance for elderly with income under $50,000; an amendment would enable certain Medicare enrollees to get Medicaid-level discounts.
(Filed 1/21/2000; read second time in Senate; did not pass as of end of regular session, 4/6/2000)

Governor Cecil Underwood signed an executive order creating a new program for Medicare beneficiaries with incomes no higher than 300% of federal poverty. Prescription drugs will be available at the discount rate currently negotiated by the WV Public Employees Insurance Agency. To qualify for participation in the West Virginia Prescription Assistance Network II, total income for 1999 must have been $25,050 or less for a single person, or $33,750 or less for two people.
(Executive order 20-00 signed 10/18/2000. Enrollment opened on Nov. 1, 2000)
Governor's news release 10/18/2000; Agency description on-line, 1/2001;
The toll-free SPAN II telephone number is: 877 987-4463.