November 30, 2009

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MMA to Dedicate John C. Dalco House on Friday, December 4th

MMA members and friends are all invited to join us on Friday, December 4, 2009 for the dedication of the John C. Dalco House,  the new home of the Medical Professionals Health Program (MPHP).  The new home, named for Dr. Dalco who was the first Medical Director of what was originally called the Physician Health Program, is located at 20 Pelton Hill Road in Manchester, adjacent to the MMA offices in the Frank O. Stred Building.  The dedication event will take place at 11:30 am followed by a luncheon at the Augusta Country Club.

The ranch style property, owned by the Maine Medical Education Foundation, recently has been renovated to accommodate the increased number of staff to the program.  Additional staff has been hired to handle the additional referrals to the program anticipated by the addition of nurses to the program, effective January 1, 2010.  Currently, the program serves physicians (MD's and DO's), dentists, dental hygienists, physician assistants, and pharmacists.  By January, it is anticipated that the program will have an administrative assistant, an administrative director, a full-time case manager, a clinical director, and a part-time medical director. 

At the event on Friday, Clare Dalco, Dr. Dalco's widow, and one of his sons, John, Jr., will be present at the ceremony to represent the Dalco family.   All MMA members and the public are invited to attend the ceremony at 11:30 am at the property.  Following the brief ceremony, a luncheon will be held at the Augusta Country Club.   There is a charge for the luncheon.  Anyone wishing to attend the luncheon should contact Dee deHaas at MMA at 622-3374, ext. 215 or via e-mail to

Dr. Dalco was hired to be the first Medical Director of the Physician Health Program in 1987.  He retired fifteen years later and died in February 2006.  Dr. Dalco also operated the program in New Hampshire and served on the Physician Health Committee at the Massachusetts Medical Society.  He is fondly remembered by many physicians in Maine and was a very effective advocate for the interests of physicians recovering from substance abuse. 

David Simmons, M.D., of Calais, worked as Assistant Medical Director with Dr. Dalco and then became Medical Director of the Program in 2002.  Dr. Simmons resigned his position for health reasons in October of this year and the Association is in the process of recruiting a part-time Medical Director.  Presently, the program is staffed by Cathryn Stratton, Administrative Director, and Margaret Palmer, Ph.D., Clinical Director. 


Committee on the Implementation of the Maine Medical Marijuana Act to Meet on Tuesday

The Committee on the Implementation of the Maine Medical Marijuana Act will meet from noon to 3:30 pm on Tuesday, December 1st in the DHHS Commissioner's Conference Room located at 221 State Street in Augusta.  DHHS Commissioner Brenda Harvey will chair the 14-member group that includes MMA EVP Gordon Smith, Esq., as a representative of physicians.  The Committee also will meet on December 8th (same time and place) and December 15th (1:00 pm to 4:00 pm) and is expected to report recommendations back to Governor Baldacci by December 31, 2009.

The law passed by the voters takes effect on February 21, 2010 and DHHS must complete rulemaking to implement the law within 120 days following the effective date.  The Governor's Executive Order establishing the Committee states that, "there are numerous policy and procedural issues involving various interests and stakeholders that must be considered and resolved in order to effectively implement the law . . . "

The law passed by voters in November allows a physician to provide a written certification stating that in his or her professional opinion a patient is likely to receive therapeutic or palliative benefit from the medical use of marijuana to treat or alleviate the patient's debilitating medical condition or symptoms associated with the debilitating medical condition.  "Debilitating medical condition" is defined in the law and is much broader than the medical conditions in the prior law, also initiated as a direct voter initiative in 1999.  MMA anticipates that there will be a lot of questions from members about the new law during its implementation.  Some of these questions will involve the appropriate action to take when a patient who is already on chronic opioid therapy also wishes to try marijuana.

The input of physicians will be important to the deliberations of the Committee.  Those members wishing to provide their thoughts on the new law are invited to communicate with Mr. Smith, MMA's EVP, at 622-3374, ext. 212 or via e-mail to  Depending upon the amount of interest, it may be desirable to form a physician advisory committee to provide input over the coming months.

MMA will continue to provide information on the deliberations of the Committee through the Weekly Update and through the pages of Maine Medicine.



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MMA Operations Committee Meeting via Conference Call Tonight

MMA's Operations Committee, which acts on behalf of the Executive Committee between meetings of the Committee, will meet via conference call at 8:00 pm tonight (November 30th).  The Committee is chaired by Nancy Cummings, M.D., Chair of the Executive Committee, and consists of the MMA officers and two members at large.  The seven-member committee will work through an agenda that includes the following items (partial listing):

  • Whether the Association should apply for one of the seven grants available from the federal Agency for Health Research & Quality to model alternative systems of medical liability or examine new systems improving patient safety.

  • Whether the Association should join the state in applying for a grant from the federal comparative effectiveness funds in order to enhance the existing academic detailing project.

  • Continuing MMA efforts in support of comprehensive health care reform.

  • Finalizing the agenda for the December 16th Executive Committee meeting and January Executive Committee retreat.

  • Review MMA activities regarding the new Maine Medical Marijuana Act.

  • Consider appointments to fill E.C. vacancies.

  • Consider an appointment to the state's Drug Utilization Review (DUR) Committee.

  • Review 2009 finances through eleven months, compared to budget.

Minutes of the meeting will be posted on the Member's Only section of the MMA website ( once they are approved by the Executive Committee on December 16th. [return to top]

MaineCare Annual PDL Changes Effective January 1, 2010

The State of Maine has recently completed the annual review of all PDL categories and the drugs within those categories. The following is a list of the major changes to the PDL for 2010.  For a complete list of the Preferred Drug List please refer to 




Provides a low pill burden mesalamine alternative


Additional preferred carbonic anhydrase inhibitor alternative


Kadian 80mg & 200mg are non-preferred.


Clinical PA is required to establish diagnosis and medical necessity.

Lexapro Tabs

See Lexapro splitting table


Clinical PA is required to establish diagnosis and medical necessity.


Savella available w/o PA for fibromyalgia if first line generic in profile: TCA, Cyclobenzaprine or Gabapentin.

Trileptal Susp

No generic alternative

Venlafaxine ER Tabs

Replaces Effexor XR, available in 225mg tablet to consolidate doses.




Notes/PA Criteria

Actoplus Met


Avandamet Tabs

Requires use of Actos, Metformin, or other preferred anti-diabetics.

Actos 30mg Tabs

Actos 45mg Tabs

Actos 30mg or 45mg - please use multiple 15mg tabs.



Dosing limits apply.


Current users of Avandia who have tried Actos will be able to continue use of Avandia.

Augmentin XR TB12

Use preferred generic amoxicillin/clavulanic acid alternatives


Use Actos  15mgs with generic glimepiride


Notes/PA Criteria


Clinical PA is required for members on highly emetic anti-neoplastic agents.

Enbrel 50mg

Please use multiples of 25mg or other preferred TNFs (Humira, Cimzia)


Must fail all preferred products before moving to non-preferred.


PA required to confirm FDA approved indication.

Fosamax Tab

and Plus D

Please use Alendronate and Vitamin D.





Prescribers with >= 10 ART scripts per quarter and 75% ART PDLcompliance will be exempt from PA for these products.



All preferred medications must be tried.

Lialda Tabs

Current Lialda users grandfathered (1.1.10)


Lyrica- Second line therapy for Diabetic Peripheral Neuropathy and Post Herpetic Neuralgia. With Fibromyalgia diagnosis, Lyrica will not require PA if previous 4 week trials of the following are seen in drug profile at full therapeutic doses: TCA or cyclobenzaprine, gabapentin, and Savella.


Please use preferred brand Starlix


Will re-evaluate at January DUR meeting

Peg-Intron Kit

Current users are grandfathered. Pegasys preferred.

Pentasa 500mg

Use multiple Pentasa 250mg

Pulmicort Flexhaler

Use preferred inhaled steroids


Current users must switch to other preferred alternatives


MaineCare will approve Synagis PA's for start date of November 23rd for infants who meet the guidelines.  PA will be approved for max of 5 doses.  Maximum 1 dose/30 days.


Use preferred Sumatriptan and Naproxen separately.


Please use preferred nasal steroid (fluticasone or Nasonex)

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Stop the DEA From Criminalizing Routine Geriatric Care in Nursing Homes [return to top]

MMA's Legislative Committee Meets Tomorrow Evening

The MMA's Legislative Committee, chaired by Lisa D. Ryan, D.O., will hold its organizational meeting for the Second Regular Session of the 124th Maine Legislature from 6  to approximately 8:30 p.m. tomorrow evening at the MMA headquarters in Manchester.  The meeting agenda includes:

  • Administrative matters in anticipation of the new legislative session;
  • Review of the current make-up of the Maine legislature and the 2010 gubernatorial race;
  • Discussion of the Maine Medical Marijuana Act and Committee on the Implementation of the Maine Medical Marijuana Act
  • Review of key bills carried over from the First Regular Session; and
  • Review of bills of interest admitted by the Legislative Council for consideration during the Second Regular Session.

Any member who is interested in the MMA's advocacy work are welcome to attend.  Practice CEOs or managers also are welcome.  Please RSVP to Maureen Elwell, Legislative Assistant, at 622-3374, ext. 219 or at so that we can plan appropriately for food. [return to top]

MeCDC Convenes Stakeholders on School-Mandated Vaccines, December 3rd

Maine CDC was requested by the Health and Human Services Committee of the Legislature to convene a group of stakeholders on school-mandated vaccines and report back on our findings.  The main questions that will be discussed are:  what criteria Maine should use for considering mandating a vaccine for school attendance (and “mandate” in this case refers to a requirement with opt outs based on medical, religious, or philosophical reasons) and what vaccines should therefore be considered by policymakers for mandating.  There may also be a question regarding exclusions for those children not vaccinated. 

The preliminary agenda plans are:  to review the list of criteria for considering school-mandated vaccines from the AAP (see below);  to revise these criteria, as desired by the group, hopefully reaching consensus on criteria for Maine to use; to rate each recommended childhood vaccine based on these criteria; and to develop draft recommendations for the HHS Committee on possible revisions to Maine’s school mandated vaccines.   

Interested Physicians are welcome to attend this meeting, scheduled to occur on Thursday, December 3rd, 11am – 2 pm at the Augusta Civic Center, Lincoln/Oxford Room.  For more information, please contact Kellie Miller, Director of Public Health Policy at or by phone at 622-3374, ext. 229.

Criteria for Considering School-Mandated Vaccines:


·         A process exists  for parents to opt out of immunization requirements;

·         The vaccine(s) containing the antigen is accessible,

·         Cost is not a barrier;

·         The vaccine has been provided to all children for free for at least 2 years, though the waiting period could be waived if there is a “pressing public health need”. 

10 Criteria:

  1. The vaccine is ACIP recommended and included in its recommended immunization scheduled for children

  2. Effectiveness is established by immunogenicity

  3. Vaccine is cost effective from a society perspective and is as cost-effective as other vaccines

  4. Vaccine is safe with an acceptable level of adverse effects

  5. Vaccine prevents disease that is a public health burden

  6. Vaccine reduces transmission risk

  7. There is public acceptance of the vaccine among the public and the medical community

  8. The burden of compliance is low – on schools, providers, and governmental public health

  9. The burden of compliance is reasonable for the parents/caregivers

  10. The vaccine has a direct relationship to increasing safety in the school environment


A Critique of Criteria for Evaluating Vaccines for Inclusion in Mandatory School Immunization Programs

Pediatrics August 1, 2008

PEDIATRICS Vol. 122 No. 2 August 2008, pp. e504-e510 (doi:10.1542/peds.2007-3218) [return to top]

Two More Deaths Reported From H1N1 influenze in Maine

Two more deaths have been reported resulting from H1N1 influenza in Maine, bringing the total to nine since August, according to the Maine CDC in the Department of Health and Human Services.

"It was reported that an Androscoggin County resident and a Franklin County resident, both 25 – 65 years of age died this past week of confirmed H1N1.  Both had multiple serious underlying conditions.  While most people with H1N1 in Maine and the nation have had a relatively mild infection, this news demonstrates how severe influenza can be, especially in adults with underlying conditions, pregnant women, and children," according to a statement released by the Maine Center for Disease Control and Prevention.

H1N1 flu continues to be widespread in Maine.  This past week 31 Maine people have been hospitalized, including eight children.  Three of these hospitalizations were to intensive care units.  270 new cases of H1N1 were identified through testing, including cases from all 16 counties.  29 K-12 schools have reported high absentee rates this past week, bringing the total to 172 schools reporting high absentee rates since the beginning of the H1N1 pandemic.  Visits to emergency departments and outpatient offices for flu are still high but have decreased this past week.

Public Health Officials say H1N1 vaccine continues to flow into the state and that the MeCDC is distributing increasing amounts of vaccine to health care providers for their high priority patients including adults with underlying medical conditions, children, pregnant women, as well as caregivers and household contacts of infants less than 6 months old.  There is also access to prescription antiviral medicines for those at high risk for complications and who have symptoms or whose household contact has symptoms.  These medicines are available for free through a prescription and the state-purchased stockpile for those who do not have funds to pay for them and lack adequate insurance.

Since first being recognized in April 2009, novel influenza A (H1N1) has spread across the globe.  In June, a pandemic was declared by the World Health Organization.  Children and young adults are disproportionately affected by H1N1, accounting for the majority of confirmed cases, hospitalizations, and deaths.  An estimated 4,000 people in the United States have died of H1N1.  In August, a York County man in his 50s was the first Maine resident reported to die of the pandemic strain of H1N1.

Over the past three weeks, H1N1 has become widespread in Maine and seven other adults have died from H1N1.  All people who have died thus far in Maine have had underlying conditions, most very serious ones.  The previous seven deaths include:  a young adult from Penobscot County; three adults ages 25 – 65, one from Penobscot County, one from Hancock County, and one from Washington County; and two adults >65 years of age, one from Kennebec County and one from Penobscot County.

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Dirigo Health Agency Reports Gradually Reducing Debt Load

At its recent regular meeting, the Dirigo Health Agency staff provided a brief financial report on the agency’s reduction of debt.  Currently, the debt load for the end of October 2009 is -$21,389,513.18 and if all of the payers would have paid on time this amount would have been reduced to -$18,788.681.51. 

Staff indicated that one of the challenges that the agency faces is an increase of 12% more members than anticipated and it’s a strain on the subsidy payments.  Staff also reported that the renewal rates were kept to single #% increase, but they anticipate people will terminate.  The increases were:   for a small group = 8.5% increase and for an individual = 8.1% increase.  However, it was noted that the average small group increase in the overall market was 22%, so the agency anticipates a migration of small groups to DirigoChoice. 

The total number of member months since the inception of the program (7/1/05) = 607,028, representing 25,000 members.

Also, 2 bids have been submitted for the new contract year:

1)     Harvard Pilgrim Health Care; and

2)     Celtic (which is the Medicaid management organization and has a presence in MA)  Centene acquired Celtic in 2008 and for more information to go for an outline of the different products they offer in the different states.

Dr. Josh Cutler briefly summarized where the MQF is on the MRSA issue in defining “high risk populations.”  Being that the work group didn’t have consensus on this issue, the Maine Quality Forum is trying to have the stakeholders agree that a high risk population may not be the same in each community and that there is a need to minimally acknowledge that these are the pre-determined high risk populations and accept this definition.  The upcoming legislation, LD 2198, supposedly is the bill that will require the hospitals to actually report the # of people who have tested positive for MRSA.  Maine received a $967,000 ARRA grant to control emerging infectious disease and they will be targeting MRSA. 

The Board also met for 1 hour on November 23 regarding the SOP settlement agreement of $1,689,800, but not all plans signed the settlement.  The public hearing is slated for December 16th at 9 am in the Health and Human Services Committee Room at the State House in Augusta. [return to top]

U.S. Senate Begins Health Care Reform Debate Today

Following the cloture vote of just over a week ago, Senate Majority Leader Harry Reid (D-NV) opened the health care reform debate in the U.S. Senate today.  The contentious debate is expected to continue for weeks, but the Senate Democratic leadership hopes to have a bill passed before January 1, 2010.

You can read the AMA's coverage of today's debate on the web at:

You can also read coverage of today's debate on CNN online at: [return to top]

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