Addressing The Rising Costs of Prescription Medication

Every year thousands of Mainers are forced to cope with the sky-rocketing costs of prescription medication by forgoing the healthcare they need.

Last year alone, nearly one in three Maine adults skipped a dose of their medicine, split their pills in half, or didn't fill a prescription because of the cost. The long-lasting economic impact of the COVID-19 pandemic has done little to alleviate these concerns for many Mainers.

This legislative session lawmakers in Augusta are once again looking to make prescription drugs more affordable for Maine families.

Much to the dismay of the pharmaceutical industry, Senator Ned Claxton has introduced LD 1636, An Act To Reduce Prescription Drug Costs by Using International Pricing. This bill would require a study to see how much Mainers could be saving if we utilized an international reference rate for the 100 most utilized and 100 most costly drugs.

During a February hearing on the proposed legislation, Senator Claxton and Mainers across the state voiced their support for the model bill, which was drafted and supported by the National Academy for State Health Policy’s Center for Drug Pricing.

“LD 1636 is an attempt to decrease the amount of money that the state of Maine and those who are insured by it pay annually for medicines,” Senator Claxton said. “By tying rates to well-established processes in Canada, we could save significant money for both the state and those who are insured by it."

Our lawmakers recognize that older Mainers, middle-to-low-income families, and people living with disabilities are disproportionately affected by the rising costs of prescription medication. Mainers for Working Families applauds Senator Claxton for taking steps to combat the rising costs of prescription drugs in Maine.

Easy Enrollment: Ensuring Every Mainer has Affordable Healthcare

Two years into the COVID-19 pandemic, it has never been more important for Mainers to have access to affordable healthcare. Yet costs continue to skyrocket, and it is even harder to receive care than it was before. It’s believed that about 5.1 percent of Mainers lack health insurance right now.

That’s why Rep. Dr. Richard Evans of Dover-Foxcroft introduced LD 1390, “An Act To Maximize Health Care Coverage for the Uninsured through Easy Enrollment in the MaineCare Program or in a Qualified Health Plan in the Marketplace.” If enacted, the bill would help the state identify individuals and families that do not have health insurance, but who may be eligible for MaineCare or a health plan in the Maine Health Insurance Marketplace, by asking tax filers about their health insurance status on state income tax forms. The Department of Health and Human Services and the Maine Health Insurance Marketplace (CoverME), respectively, would then contact uninsured individuals and families and help them to enroll in an affordable health insurance program.

WATCH: Rep. Richard Evans on LD 1390

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Dr. Evans explained why an early enrollment program is a critical tool in the pursuit of affordable healthcare in his testimony to the Health Coverage, Insurance and Financial Services Committee:

“Too often, individuals and families find that trying to navigate the system by themselves becomes overwhelming and perplexing. They simply give up, postponing necessary preventive care because they cannot access the system or get the help that they so desperately need. Others do not have a computer and many more do not have broadband access. Still others simply cannot afford the associated costs of health care, and their primary source of care becomes the emergency room. This should not have to happen, but for many it is their only recourse. The health care ‘churn’ is not only burdensome, but it is also disruptive to patient care continuity and can lead to poorer health outcomes.”

“The whole purpose behind LD 1390 is that rather than having the patient jump through hoops, to have the state be proactive,” Dr. Evans added in an interview with Mainers for Working Families.

The Maine House and Senate passed LD 1390, which is now sitting on the appropriations table awaiting funding. The bill must receive funding from the Appropriations Committee this session in order to become law.

We applaud Rep. Evans for his work to expand healthcare options for all Mainers, and we hope LD 1390 will make its way to Governor Mills’ desk in the very near future.

Fixing the “Family Glitch” in Maine and Nationwide

The Affordable Care Act was a major step forward for health insurance in the United States. For the first time, millions could access healthcare coverage at affordable rates, rather than pay through the nose or avoid seeing a doctor altogether.

But the ACA as it currently stands includes a “family glitch.” In cases where workers can afford employer healthcare plans for themselves, their whole family loses eligibility to buy healthcare plans in the ACA marketplace at a reduced price, even if the employer’s plan doesn’t offer affordable coverage for family members. This issue leaves about 5 million Americans uninsured, 34,000 of whom are Mainers.

Take Winslow resident John Farr, for example. When John was promoted to a coordinator position at the T-Mobile call center in Oakland, his salary was raised just $600 ($50 per month) beyond the limit for MaineCare. While T-Mobile offered health insurance, John didn’t make enough to also cover his wife and three children. It was two years before he could afford healthcare coverage for his family.

But that may soon change. Earlier this week, President Biden announced that his administration proposes to eliminate the “family glitch” once and for all in 2023. By providing families who can’t access “affordable” family healthcare coverage through an employer with a premium tax credit, they will be able to purchase an affordable plan through the health insurance marketplace. This move is expected to lower the cost of healthcare for one million Americans, and cover an additional 200,000 uninsured people. No action from Congress would be necessary to make this change.

“Once today’s proposed rule is finalized, starting next year working families in America will get the help they need to afford full family coverage,” Biden said on Tuesday.

Governor Mills applauded the Biden Administration’s announcement:

“This proposed fix would extend affordable health coverage to an estimated 34,000 people in Maine – a welcome development as we continue our work to expand access to health care in Maine. Having health insurance saves lives, keeps people healthy, reduces costs to families, and keeps people working and contributing to our economy. This fix is good for the health of Maine people and the health of our economy.”

If passed, family members of workers in need of affordable coverage can access it through CoverME.gov, Maine’s Health Insurance Marketplace. After Governor Mills launched CoverME last fall, over 66,000 Mainers obtained healthcare plans through the state marketplace. Maine’s uninsured rate is now 5.1 percent, below the national average. This is just one of many healthcare achievements our leaders in Augusta have made since Governor Mills took office three years ago.

Mainers for Working Families commends our leaders in the Maine Legislature and Governor Mills for their efforts to make healthcare more accessible and affordable. Every Mainer deserves quality healthcare they can afford.