| | | amount required by this paragraph without compromising the | | best interest of recipients of the elderly low-cost drug | | program, the department shall report to the joint standing | | committee of the Legislature having jurisdiction over health | | and human services matters and the joint standing committee | | of the Legislature having jurisdiction over appropriations | | and financial affairs in the First Regular Session of the | | 119th Legislature. |
|
| | | Upon receipt of data from the department, the pharmaceutical | | manufacturer shall calculate the quarterly payment. If a | | discrepancy is discovered, the department may, at its expense, | | hire a mutually agreed-upon independent auditor to verify the | | pharmaceutical manufacturer's calculation. If a discrepancy is | | still found, the pharmaceutical manufacturer shall justify its | | calculation or make payment to the department for any additional | | amount due. The pharmaceutical manufacturer may, at its expense, | | hire a mutually agreed-upon independent auditor to verify the | | accuracy of the utilization data provided by the department. If | | a discrepancy is discovered, the department shall justify its | | data or refund any excess payment to the pharmaceutical | | manufacturer. |
|
| | | If the dispute over the rebate amount is not resolved, a request | | for a hearing with supporting documentation must be submitted to | | the Administrative Hearings Unit. Failure to resolve the dispute | | may be cause for terminating the drug rebate agreement and | | denying payment to the pharmaceutical manufacturer for any drugs. |
|
| | | Any prescription drug of a manufacturer that does not enter into | | an agreement is not reimbursable unless the department determines | | the prescription drug is essential. |
|
| | | All prescription drugs of a pharmaceutical manufacturer that | | enters into an agreement pursuant to this subsection that appear | | on the list of approved drugs under this program must be | | immediately available and the cost of the drugs must be | | reimbursed except as provided in this subsection. The | | commissioner may impose prior authorization requirements on drugs | | under this program. If the commissioner establishes maximum | | retail prices for prescription drugs pursuant to section 2693, | | the department shall adopt rules for the elderly low-cost drug | | program requiring the use of a drug formulary and prior | | authorization for the dispensing of certain drugs to be listed on | | a formulary. Rules adopted pursuant to this subsection are | | routine technical rules as defined in Title 5, chapter 375, | subchapter II-A |
|
| | | Sec. GGG-5. 22 MRSA §254, sub-§8-A, as amended by PL 2001, c. 691, §1 | | and affected by §6, is repealed. |
|
|
