Disruption of MaineCare Pharmacy Claims due to Cybersecurity
- Maine Based Pharmacies Qualifying for MaineCare Interim Payments (PDF) - March 18, 2024
- Pharmacy Technical Instructions For Backlog Claims Processing (PDF) - May 6, 2024
- MaineCare Provider Pharmacy Interruption FAQ (PDF)
Checking Eligibility
You can call the automated Interactive Voice Response (IVR) to check member eligibility. See the IVR Eligibility Check Instructions (PDF).
Preferred Drug List
- MaineCare Pharmacy Preferred Drug List (PDF)
- Diabetic Supply List (PDF)
- Over the Counter Rebate List (PDF)
Drug Utilization Review (DUR)
- DUR Committee Meeting Schedule
- 2024
- June 11, 2024 Public Session 6:00PM - 8:00PM
- September 10, 2024 Public Session 6:00PM - 8:00PM
- November 5, 2024 (Annual Meeting) Public Session 2:30PM - 5:00PM
- December 10, 2024 Public Session 6:00PM - 8:00PM
- 2024
- DUR Committee Meeting Agendas
- DUR Committee Meeting Minutes
- Guidelines for Providing Public Comment to the ManeCare DUR
- Guidelines providing public comment MaineCare DUR Committee (PDF)
BIN & PCN for MaineCare Pharmacy Claims Processing
State of Maine Maximum Allowable Costs (SMAC)
- Current SMAC List
- Proposed SMAC list
- SMAC Dispute Form (PDF)
Standing Orders
COVID-19 At-Home Tests and Collection Kits
This MaineCare Standing Order (PDF) authorizes Over the Counter (OTC) COVID-19 at-home tests.
Naloxone
This Standing Order for Prescribing Intranasal and Injectable Naloxone products authorizes licensed pharmacists to create a prescription for and dispense naloxone products to eligible MaineCare members.
Nicotine Replacement Therapy (NRT) Products
This Standing Order for Dispensing Nicotine Replacement Therapy Products to MaineCare Beneficiaries (PDF) authorizes licensed pharmacists to dispense medically appropriate NRT products to eligible MaineCare members who require the products for help with smoking cessation or vaping cessation.
Non-Prescription Oral Contraceptive Products
This Standing Order authorizes licensed pharmacists to create a prescription for and dispense medically appropriate oral contraceptive products to eligible MaineCare members.
Medications for Treatment of Opioid Use Disorder (MOUD)
See the following documents for guidance about the Prior Authorization (PA) process for Buprenorphine:
- Prior Authorization Form for Buprenorphine and Suboxone (PDF) - July 2021
- Coverage and Prior Authorization (PA) Criteria for Buprenorphine for Treatment of Opioid Use Disorder (PDF) - July 2021
- Frequently Asked Questions: MaineCare / Change Health Care Prior Authorization Processes for Buprenorphine for Treatment of Opioid Use Disorder (PDF) - July 2021