AUGUSTA – A bill from Senate President Troy Jackson, D-Allagash, that seeks to improve transparency in prescription drug coverage, was signed into law by Governor Janet T. Mills last week. The new law – LD 2114, Resolve, Directing the Superintendent of Insurance to Collect Data from Health Insurers Related to Prescription Drug Coverage of Generic Drugs and Biosimilars – will shine a light on how health care plans cover generic drugs and biosimilars compared to brand-named counterparts.
“The cost of health care in this country is outrageous, especially when it comes to prescription drugs. However, it’s becoming clear that part of what drives up the cost of lifesaving medication is the murky system for pricing prescription drugs and the preferential treatment health insurers give brand name drugs,” said President Jackson. “This new law will uncover whether or not health insurance companies are playing games to drive patients to brand-named drugs when cheaper options are available. More importantly, the Superintendent’s findings will equip lawmakers with the information necessary to take meaningful action on behalf of Maine patients.”
The new law directs the Maine Bureau of Insurance Superintendent to request data from health insurance carriers related to each carrier’s placement of generic drugs and biosimilars on the carrier’s prescription drug formulary. This data request includes whether or not a generic drug or biosimilar is available with a lower out-of-pocket cost than the brand-named equivalent and whether preferential treatment is given to brand name drugs over their generic or biosimilar equivalents when both are covered.
“Biosimilar and generic drugs play an important role in creating competition and driving down prescription drug prices. However, this only works if consumers are given access to these alternatives and have a financial benefit to selecting lower-cost options. Health plans should not design formularies in such a way that artificially creates demand for more expensive prescription drugs and forces consumers to pay higher out-of-pocket costs for the medicine they need,” said Kate Ende, Maine Consumers for Affordable Health Care at the public hearing. “Maine people should be given access to the most affordable and medically appropriate prescription drugs that are available, including generic and biosimilar drugs that are available at a lower cost.”
Generic medication is often significantly cheaper than the brand-named equivalent. Each year, the Maine Health Data Organization publishes a list of the top 25 costliest drugs prescribed in the state and the top 25 drugs with the most significant year-to-year increase. Of the 25 drugs listed in each category from last year, all are brand-named medications.
A recent poll from the Kaiser Family Foundation found that one in five Americans have gone without medication because they cannot afford to fill a prescription and one in 10 Americans have resorted to not taking their medication as prescribed due to cost.
The Superintendent must report findings and recommendations to the Legislature’s Health Coverage, Insurance and Financial Services Committee no later than Feb. 15, 2025. The Committee may report out a bill based on the recommendations of the superintendent.
LD 2114 is set to take effect 90 days after the Legislature adjourns sine die.
