Medicare Compliance & Reimbursement

A state program that could point toward lower reimbursement for the nation's drugmakers came one step closer to implementation April 19. The U.S. Supreme Court lifted an injunction on "Maine Rx," a program designed to provide access to prescription drugs to Maine residents who aren't eligible for Medicaid. Under the program, state officials can impose a Medicaid prior-authorization requirement on products manufactured by drugmakers who don't give the state substantial rebates on Maine Rx-related purchases. Other states have been closely watching the case as they look for ways to expand access to drugs without breaking the bank. The Pharmaceutical Research and Manufacturers of America filed suit over the program, and initially won an injunction barring the state from implementing it. In PhRMA v. Walsh (No. 01-188), however, the Supreme Court lifted the injunction, arguing that PhRMA failed to adequately establish that Maine Rx was preempted by federal Medicaid statutes or amounted to a violation of the commerce clause of the U.S. Constitution. The high court's ruling is by no means the last word on the matter. The court merely lifted the injunction, and continued litigation on the merits of the program is likely. Indeed, the court explicitly declared that its ruling did not "finally determine the validity of the Maine Rx Program." Lesson Learned: Watch Maine Rx - It could prove a bellwether for aggressive drug rebate initiatives in other states.