July 5, 2004

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Maine's Electronic Prescription Monitoring Program Began July 1
Last Wednesday, July 1, marked the effective date of the law establishing Maine's Electronic Monitoring Program. Under the law, all pharmacies will periodically send to the state electronic batch files of all their transactions for Schedule II, III & IV prescriptions. The contractor for the program, GHS Data Management, will collect the data and generate reports that will be sent to physicians and other prescribers. The reports will be sent when a threshold for a drug has been reached by a patient. Prescribers can also request a report on a patient showing their history with these drugs. The program has been established by the Office of Substance Abuse which will provide oversight. As data is provided beginning this month, it will be several weeks before a physician is likely to receive a report.
The Office of Substance Abuse (OSA) is the state agency with oversight of the Prescription Monitoring Program.  The purpose of the program is to provide prescribers with their patient's use, misuse or abuse of prescription medications. The legislation was considered twice by the Legislature and was enacted in 2003 after initial objections by the Maine Civil Liberties Union as well as provider groups (including MMA) were overcome by amendments to the bill.

Several other states have had success with such a law, including Nevada and Utah.  After discussing the law's experience in these states with colleagues at the respective state medical societies, MMA ultimately supported the legislation, believing that privacy interests could be protected and that the need to respond to a growing problem with abuse of prescription medication (particularly among youth) was great. Overdose deaths increased dramatically in 2002 and 2003 primarily due to prescription drug abuse. 

By mid-Fall, physicians should be receiving reports with this data, if a patient has exceeded a threshold for the drug.  A physician may also request a report on a patient, showing their history with these drugs, although the history will begin only on July 1, 2004.

These reports are available only to prescribing physicians and other prescribers although patients can receive a report of their own usage and professional licensing boards (with reasonable cause) can receive copies of the reports.

OSA is preparing, with assistance from MMA, a brochure designed to assist physicians with the difficult question of what to do when they receive a report that a patient is potentially abusing the medications themselves, or sharing or selling the medications to others.  When completed, the brochure will be available at http://www.maineosa.org (or you may obtain it from MMA). Frequently, the patient will need a referral to a substance abuse treatment provider.  OSA maintains an information resource center for such purposes which can be accessed through the above website or by calling 207-287-8900 or TTY: 207-287-4475.

OSA's website contains many good resources that a physician may find helpful. " Find Programs & Services" is available on the top of each web page and is an on line searchable database for treatment services throughout Maine.  In the "Data & Research" section, you will find a link to the Prescription Monitoring Program pages which have a variety of useful information including pain treatment agreements, useful links and the brochures outlining the new program.  In the IRC section you will find brochures, books and articles to better inform you and your patients about precription drugs.

OSA has recently hired a Program Coordinator for the Monitoring Program.  He is Chris Baumgartner and he is available at 287-3363 or at chris.baumgartner@maine.gov.

The contractor, GHS Data Management, Inc. is located in Maine and also maintains a website at www.ghsinc.com.

MMA Endorses Congressman Allen's Drug Comparison Bill
At its meeting on June 9, 2005, the MMA Executive Committee endorsed the Prescription Drug Comparative Effectiveness Act of 2003 (H.R. 2356) sponsored by Maine's First District Congressman, Tom Allen (D).

See the MMA's letter to Congressman Allen below:

June 25, 2004





The Honorable Thomas H. Allen

U.S. House of Representatives

1717 Longworth House Office Building

Washington, D.C. 20515



OF 2003 (H.R. 2356)


Dear Congressman Allen:


I am writing to follow up our discussion about your prescription drug comparison bill during the AMA National Advocacy Conference in late March 2004.  I am very pleased to report that the Executive Committee of the MMA finalized its support for H.R. 2356 at its meeting on June 9, 2004.  Your initiative directs the Director of the National Institutes of Health, in coordination with the Director of the Agency for Healthcare Research and Quality, to conduct research to develop valid scientific evidence regarding the comparative effectiveness, cost-effectiveness, and comparative safety relative to other drugs and treatments for the same disease or condition, of prescription drugs that account for high levels of expenditures or use by individuals in federally funded health programs. 

Maine physicians understand that we have an important role in the appropriate management of prescription drug costs for our health care system as a whole and in recommending the most affordable medication that is effective for an individual patient's condition.  Furthermore, encouraging physicians to compare drug effectiveness, cost-effectiveness, and safety is consistent with current American Medical Association policy providing that "physicians should select the lowest cost medication of equal efficacy for their patients."  (see House of Delegates Resolution 285.965, Cost Containment Involving Prescription Drugs in Health Care Plans). The data that will be produced and disseminated as a result of H.R. 2356 will be very valuable to physicians as we try to fulfill these goals. 

The MMA is pleased to join the American Academy of Family Physicians and other physician organizations in advocating for passage of this important legislation.





Maroulla S. Gleaton, M.D.



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Capital Investment Fund Rule Public Hearing Recap; Comments Due Friday
The Governor's Office of Health Policy & Finance held a public hearing on the draft rule establishing the Capital Investment Fund (CIF) on Tuesday, June 29, 2004.  The CIF proposes a methodology for determining on an annual basis, the total amount of spending the State will permit to be spent on health care projects requiring certificate-of-need (CON) review.  You can review the draft rule online at:  http://www.maine.gov/governor/baldacci/healthpolicy/reports/CIF%20rulemaking.pdf.

Written comments may be submitted by 5 p.m. on Friday, July 9, 2004 to Ellen J. Schneiter, Deputy Director, Governor's Office of Health Policy & Finance, State House Station 15, Augusta, Maine 04333-0015.  The fax number is 207-624-7608.

The following individuals testified at the public hearing on June 29th:

  • David Winslow, Maine Hospital Association
  • Paul Gray, MaineHealth
  • Cathy Gavin, Maine Health Care Purchasing Collaborative
  • Katherine Pelletreau, Maine Association of Health Plans
  • Joe Ditre, Consumers for Affordable Health Care
  • Jay Houghton, R.N., Maine People's Alliance
  • Brenda Jolly, Maine Center for Public Health
  • Rick Erb, Maine Health Care Association
  • Sara Stalling, M.D., Maine People's Alliance
  • Deborah Cook, Maine Small Business Alliance
  • Wayne Myers, M.D., retired physician on the Maine Health Access Foundation Advisory Council
  • David Brenerman, UNUMProvident
  • Mary Henderson, Maine Equal Justice
  • Pat Philbrook, Maine State Nurses Association
  • Kris Ossenfort, Maine State Chamber of Commerce

Most speakers were supportive of the draft rule but made technical comments.  Most of the consumer and business spokespeople advocated for adoption of the rule on an emergency basis because they believe that health care purchasers need cost containment now.  The Maine Hospital Association raised 4 areas of concern:

  • that the proposed formula is not specific enough;
  • that the total amount of the CIF as projected in the rule is too low and insufficient for the need;
  • that the formula does not acknowledge the one-year moratorium that expired in May; and
  • the Administrative Procedures Act (APA) rulemaking process should be followed in setting the actual amount of the CIF each year not just in setting the methodology.

The MMA did not comment at the public hearing because the little feedback we have received suggested that the draft rule's methodology seemed reasonable.  The MMA's larger policy questions about CON and the State's regulatory climate and their impact on physician recruitment and retention are beyond the scope of this rule.  If you have comments or questions about the draft CIF rule before the comment deadline on Friday, please contact Gordon Smith, EVP (gsmith@mainemed.com) or Andrew MacLean, V.P. & General Counsel (amaclean@mainemed.com). [return to top]

Upcoming Dirigo Meetings this Week
Three important Dirigo Health meetings are on tap for this week.

On Tuesday, July 6, the Commission to Study Maine's Hospitals will meet from 9:00am to noon at the DHS Office at 442 Civic Center Drive in Augusta.  The meeting is in conference rooms 1A and 1B. 

At 2:00pm on Tuesday, July 6, the Dirigo Health Board of Directors will meet at the new office of Dirigo at 211 Water St., Augusta.

On Friday, July 9, the Maine Quality Forum Advisory Council will meet from 9:00am to 11:00am, also at the new Dirigo office at 211 Water St., Augusta.  Following the meeting, the Performance Measurement Committee, chaired by Jan Wnek, M.D. will meet, also in public session.  On the agenda for the full Council meeting are an update on Dirigo Health, a discussion of a potential Maine Quality Forum web site, an update on the provision in the law regarding a revolving loan fund to assist providers with technology expenses, a report from the Technology Assessment Committee and from the Performance Measurement Committee. [return to top]

A Reminder from The Maine Physician Action Fund
With elections for every seat in the Maine House and Senate scheduled for November, 2004, the Maine Physician Action Fund (MPAF), a political action fund organized and operated by the Maine Medical Association is looking to MMA members for recommendation on candidates to support with MMA donations.  John Makin, M.D. of Waterville and Skowhegan is Chair of the MPAF.

The MPAF will be meeting over the summer to decide on distribution of campaign contributions.  The Trustees will be reviewing the voting records of incumbents on issues of importance to medicine and will also rely upon personal recommendations from MMA members.

If you have a candidate in your area that you would like to bring to the attention of the committee, please contact Andrew MacLean at 622-3374 or amaclean@mainemed.com.  As many candidates now elect to receive state funds under the so-called "clean elections law", there are fewer candidates each year to receive PAC funds. [return to top]

Watch for Annual Session Registration Materials
A final program brochure on the MMA 2004 Annual Session will be mailed late this week to each MMA member.  An earlier flyer was enclosed with the May/June Maine Medicine. The meeting is at the Colony Hotel in beautiful Kennebunkport Sept. 10-12, 2004 and 9.5 hours of category one CME will be available.  The theme of the CME portion of the meeting is "Medicine Rewired;  Putting Technology to Use in Your Practice."  The final Sunday morning program is on the Medicine and Literature Program, sponsored by the Maine Humanities Council.  The program opens at noon on Friday, Sept. 10th, with a keynote luncheon featuring Thomas Sullivan, M.D., immediate past President of the Massachusetts Medical Society.  Dr. Sullivan is one of the nation's leading experts on the subject of physicians and technology.  If you are considering purchasing an electronic medical records system in the future, you will not want to miss this program.  Six EMR vendors will be presenting on Saturday afternoon, along with presentations on what to look for in your EMR system.

The Association has not held an Annual Meeting at the Colony since 1972 and it will be good to be back where so many successful meetings were held in the mid-20th century.  A very reasonable room rate of $140 is available.  Please look over the brochure and consider attending.  More information is available from Diane McMahon at 622-3374 or dmcmahon@mainemed.com.  Potential exhibitors should contact Lisa Martin at 622-3374 or lmartin@mainemed.com. [return to top]

For more information or to contact us directly, please visit www.mainemed.com l ©2003, Maine Medical Association