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Trey Stewart represents District 2, which includes communities in Aroostook and Penobscot counties, in the Maine Senate. He is the Senate Republican leader and a member of the Legislative Council.
If Washington really wants to lower drug prices, it needs to stop looking toward Europe and start listening to the people who actually rely on our healthcare system — especially those in rural America.
Take the so-called “Most Favored Nation” (MFN) policy. This proposal from the Trump Administration, which was attempted before during his first term, promises to make drug companies charge Americans whatever they charge people in other countries. But in practice, I believe it’s a destructive price-control gimmick that would backfire big time on rural Mainers and cost American jobs, and our citizens’ access to the world’s best healthcare.
Under MFN, the government would peg U.S. drug prices to those in countries like Germany or France — places where bureaucrats often decide what medicines are “worth” and often ration care. That may work for their systems; but here in America, it could mean fewer treatments and less access for patients. Our nation should never benchmark itself against foreign governments.
Worse, MFN could even punish American medical innovation. Copying price controls from overseas could gut the very system that brought us cutting-edge treatments for diabetes and heart disease. If we really want to tackle high drug prices, ensure continued access to care and protect rural hospitals while we’re at it, we need to fix what’s broken closer to home.
Let’s start with cleaning up the 340B Drug Pricing Program. This federal program was supposed to help hospitals serving low-income and rural communities by letting them buy drugs at steep discounts. But today, massive hospital systems are essentially gaming the system by buying cheap and selling high. And rural hospitals? They’re left behind, unable to compete or survive.
One analysis showed that some hospitals made up to 500 percent profit margins on discounted drugs without passing a penny in savings to patients. That’s not charity — that’s exploitation.
Second, shine a light on the pharmaceutical middlemen. Pharmacy benefit managers (PBMs) are supposed to negotiate lower drug prices. Instead, they often act like silent middlemen who drive prices up. They choose which drugs make it onto formularies, may steer patients to their own affiliated pharmacies and take big rebates from drug manufacturers — rebates that rarely benefit consumers.
The result? Independent rural pharmacies are closing; and patients are stuck with higher out-of-pocket costs and fewer choices. Maine has passed laws to rein in abusive PBM practices. Still, PBMs — like any powerful industry — find ways around the rules. It’s time for real enforcement and tougher penalties to stop them from driving rural pharmacies out of business.
Finally, we need to fix MaineCare — the state’s Medicaid program — before expanding it. Medicaid is essential to rural states like Maine, but I believe our program is not working the way it should. MaineCare enrollment has grown every month so far this year and is under water to the tune of more than $100 million. This shortfall wasn’t fully funded in the biennial budget passed by the Legislature in March until the supplemental budget was added in June.
Maine’s expansion population flooded the rolls with able-bodied working-aged adults, who now make up 53 percent of those receiving benefits and are crowding out the resources needed for seniors, people with disabilities and children. Meanwhile, reimbursement rates are so low that hospitals lose money every time they treat a MaineCare patient — that is, if they even get paid.
The state has sometimes taken years to pay hospitals, putting massive strain on already struggling rural facilities. According to the fiscal note for one bill sitting on the Senate’s Special Appropriations Table, LD 331, it would cost the state nearly $75 million just to catch up on these past due payments.
We need a smarter approach — work and community engagement requirements like those we have proposed in Maine — to help move people from welfare to work and private insurance. We also need faster payment systems so that hospitals aren’t left holding the bag.
At the end of the day, rural communities like mine don’t need slogans or shortcuts. We need real common sense solutions that protect patients, reward American innovation, allow America to continue being a world leader in healthcare and stop letting middlemen and mega hospitals game the system.
Forget copying Europe. Let’s fix what’s right in front of us.
