A bill that aims to lower the price of the costliest prescriptions for Mainers inspired testimony from several dozen stakeholders at a public hearing Tuesday, with residents from across the state speaking largely in favor of the bill and pharmaceutical organizations strongly against it.

The bill, introduced by Sen. Ned Claxton, D-Auburn, would set an upper price limit that state entities, health plans, pharmacies or other participating payers are willing to pay manufacturers for the 250 costliest drugs for Mainers. Because of the nature of Medicaid as a partnership between state and federal governments, it is excluded from the bill.

LD 1636, An Act to Reduce Prescription Drug Costs by Using International Pricing, would require that each year, the state’s superintendent of insurance compile the list based on the previous year’s prices and cross-reference those with the wholesale price published by the Canadian government for its four most populous provinces.

The legislation was written to focus on the payer and not on the manufacturer, and does not set the price of drugs, which would likely not withstand a constitutional challenge, said Jennifer Reck, a policy director with the National Academy for State Health Policy’s Center for Drug Pricing.

Claxton’s bill is based on model legislation drafted by policy and legal experts from the academy, a nonpartisan and nonprofit forum for state policymakers with offices in Portland and Washington, D.C.

A number of individuals testified before the Legislature’s Committee on Health Coverage Insurance and Financial Services that they are desperate for relief from the high cost of prescription drugs.

Vilene Farina of Lewiston wrote to the committee that she was diagnosed with breast cancer last October. The cost for her life-saving medication is in “the thousands of dollars.”

She said that while she has insurance that covers a chunk of the cost, she has met others who are forced to choose between purchasing food or the cancer-fighting drugs.

“The stress of having to pay such high costs is causing more issues,” she wrote. “We need to get the high costs of these prescription drugs down so that people in Maine can afford to live, (so) that we don’t have to choose between taking a life-saving drug and eating or feeding our families.”

Sabrina Fuhrer’s son and brother both have Type 1 diabetes. The Old Town resident said she watched for years as her parents struggled to pay for her brother’s medications.

When her father became seriously ill and needed dialysis and various medications to live, he ultimately decided to forgo treatments.

“I knew a large part of his reason was that he did not want the family to have one more medical cost to think about,” Fuhrer said.

Now, she said, she lives in “constant fear” of what might happen if her son loses his MaineCare coverage. The out-of-pocket cost for his insulin is $650 a month.

Even with health insurance, the monthly cost of life-maintaining medications for individuals with chronic diseases, such as diabetes, Crohn’s disease and arthritis, may be in the thousands of dollars due to the high price of those drugs.

Those same medications cost a fraction of the price across the border in Canada.

Jane Horvath, an independent health policy analyst, told legislators Tuesday that the bulk of pharmaceutical companies’ revenues come from the U.S.

“But we don’t get the best deal,” she said. “We’re their best customer, but we do not get the best deal,” which speaks to the “market dysfunction” that legislation like Claxton’s bill is trying to correct.

In opposition to the bill, however, were the trade organizations that represent pharmaceutical companies and others in the prescription drug landscape.

Several Maine lawyers testifying on behalf of organizations like Pharmaceutical Research and Manufacturers of America, or “PhRMA,” suggested that the bill would not withstand legal challenges.

But legal experts who testified at Tuesday’s hearing on behalf of the National Academy for State Health Policy said the bill was written to withstand those legal challenges.

The legal ramifications of the bill were not the only issues the pharmaceutical representatives took umbrage with.

“Allowing the government to set prices at the lowest price in Canada could restrict patients’ access to medicines by reducing the availability of life-saving therapies in the state,” Nick Doherty, policy director for PhRMA, told lawmakers.

Others who spoke in opposition were representatives of Anthem Blue Cross and Blue Shield, a federation of U.S. health insurance companies; Biotechnology Innovation Organization, which lobbies on behalf of the biotechnology industry; Pharmaceutical Care Management Agency, a trade organization that represents pharmacy benefit managers; Healthcare Distribution Alliance, a national organization representing pharmaceutical distributors; and CancerCare, a New York-based firm providing support for individuals with cancer.

The only local entities to speak in opposition to LD 1636 were the Southern Maine Chronic Pain Support Group and Eric Cioppa, the state superintendent of insurance, who also said that this bill could create a situation in which “nobody is willing to sell the drug at a price the carrier or state agency is permitted to pay.”

Horvath, the independent health policy analyst, called this line of reasoning a scare tactic.

The chronic pain support group, represented by Ernie Merritt of Saco, spoke specifically to a provision in Canadian law on drug pricing called the “Quality-Adjusted Life Year,” which is a measure of health outcomes.

“QALY devalues the lives of people who are elderly or disabled. According to this standard, their lives aren’t worth the investment in these medications because they may not live as long as other people,” Merritt said in a written testimony.

The pain support group, along with CancerCare, argued that because Canadian drug prices incorporate QALY, the benefits of the bill will be out of reach for those with chronic or terminal illnesses.

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