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 terms of the latest legislative activities, in 2019, Maine Governor Janet Mills signed into law LD 1, which requires insurers to continue offering the 10 essential benefits and protections provided under the Affordable Care Act, regardless of the fate of the ACA. The state also made strides in pharmaceutical legislation, passing bills to regulate PBMs (LD 1504), increase drug price transparency (LD 1162), allow drug importation from Canada (LD 1272), and establish a Drug Affordability Review Board (LD 1499).
The Legislature also tackled prescription drug pricing in 2018, when it passed a bill to promote prescription drug price transparency (LD 1406), 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.
2020 Legislative Session: 1/8/2020 - 4/15/2020 (2019-2020 term). *Current session bill updates are ongoing. Check back weekly for updates.
STATE BUDGETMaine enacts budgets on a two-year cycle, beginning July 1 of each odd-numbered year. Maine’s new Biennial Budget will take effect on July 1, 2020 and is valid through June 30, 2021. To view Maine’s 2020-2021 Budget, click here.
REGULATION & ENFORCEMENT
- Maine v. MaineHealth, Maine Sup. Ct. No. 13CD-11-285 (2011): In 2011, Maine’s Attorney General challenged Maine Medical Center’s (MCC) proposed acquisition of the two largest cardiology groups in southern Maine: Maine Cardiological Associates (MCA) and Cardiovascular Consultants of Maine (CCM). MMC is controlled by MaineHealth (MH), the largest health system in southern Maine. The parties had applied to the Maine Department of Health and Human Services (Maine DHHS) for a certificate of public advantage under 22 M.R.S. §§ 1841-52, the Hospital and Health Care Provider Cooperation Act. But, the cooperative agreement was ineligible for a certificate of public advantage (or immunity from federal antitrust laws) because the law is limited to horizontal mergers, whereas this deal was vertical in that it would combine a hospital and physician practice. Instead, the state challenged the merger. Eventually, the state and the parties entered into a five-year consent decree imposing conduct remedies including with regard to payments received, rates charged, services offered, employment contracts and compensation, and network affiliations. Key documents from the case, including consent decree available on state AG’s website.
- Maine was one of 16 states to file an amicus brief supporting the FTC’s winning position in the Ninth Circuit appeal of St. Luke’s Health Care Sys. v. FTC, No. 14-35173 (March 7, 2014), decided February 10, 2015. The States’ brief stated that the acceleration of health care costs due to the growth of large health care provider systems had become a matter of grave concern for the states.