Maine has been active in regulating healthcare price transparency. Maine makes available the state’s All-Payer Claims Database (APCD), for which the state has collected health insurance claims information since 2003. The APCD currently holds claims from commercial insurance carriers, third party administrators (TPAs), pharmacy benefit managers (PBMs), dental benefit administrators, MaineCare (Maine Medicaid), and CMS (Medicare).
Early in 2015, Maine passed a bill that requires health benefit plans selling plans in Maine to provide beneficiaries with an online drug formulary. The state legislature also tried—but failed—to pass a bill that would have established financial penalties for entities that are required to disclose price information under Maine’s APCD and fail to do so.
In early 2018, Maine passed a bill to promote prescription drug price transparency (LD1406), which directs the Maine Health Data Organization to report on the 25 most commonly prescribed drugs that have experienced large cost hikes. The organization must establish a plan for data collection from manufacturers, and provide Maine lawmakers with an annual report on prescription drug prices beginning in April 2019. As Congress considers the CREATES Act to promote generic drug competition, Maine has become the first in the country to enact a law that would require drugs distributed in the state to be made available at a fair market price and without restrictions to generic companies for use as samples to accelerate the development of lower-cost generics.
Additionally in 2018, Maine passed legislation to maintain parts of the Affordable Care Act’s essential health benefits over the governor’s veto. On July 30, 2018, HHS approved Maine’s state innovation waiver under Section 1332 of the Affordable Care Act (ACA) to support a state-based reinsurance program (Maine Guaranteed Access Reinsurance Association). The state expects the move to lower exchange premiums for the upcoming open enrollment.
The State Database
The Source tracks state activities impacting healthcare price and competition in both legislation and litigation in a searchable database to help stakeholders at the state level understand their legal and regulatory environment as they make efforts to improve access, quality, and efficiency, and reduce costs in healthcare. We currently cover bills from the 2017-2018 legislative term and key statutes from each state. Search the database for specific bills, statutes or cases by using keyword, key issue category, and/or jurisdiction.