Attention MaineCare Providers: Notice of Returning Pharmacy Processes Including Prior Authorizations

Aug 05, 2024

The Office of MaineCare Services continues a phased recovery following the outage that occurred from February 21, 2024, through March 26, 2024, due to the national cyber security issue affecting Change Healthcare. 

During the outage, limitations were waived regarding medications that were refilled too soon. On May 1, 2024, Reject–79 Refill Too Soon and Reject-79 Refill Too Soon Carryover were returned to normal functioning.  

We are entering the next phase of the recovery and are continuing to restore functions that had been waived. Below is the restoration plan in a phased-in approach. 

• Starting July 17, 2024, Reject-76 Plan Limitations Exceeded, will return to normal functioning.  

• Claims that have been exceeding limitations like days’ supply, daily dosage and frequency per day limits will now begin to reject. Please continue to refer to the Preferred Drug List (PDL) for limits associated with those medications. Example: Nurtec 8 tabs/30 days. 

• Starting August 5, 2024, edits for Reject-75, Prior Authorization Required, will return to normal functioning.  

• After August 5th, medications that were started during the outage that are not on the PDL will now begin to reject. Please refer to the PDL for preferred medications. 

Please continue to follow the MaineCare PDL. It is available for reference on the MaineCare Pharmacy Services page. 

The State of Maine Pharmacy Unit Home Page is restored to https://www.mainecarepdl.org/ with access to Prior Authorization forms and the MaineCare PDL.  The restored site has a new format and will continue to be updated with additional content. 

Providers requiring assistance with submitting prior authorization (PA), may contact the Change Healthcare Optum Pharmacy Helpdesk at MaineHD@optum.com or 1-888-420-9711 or 1-888-445-0497.