Attention Pharmacy Providers: Status of Restoration of Maine Point of Purchase System (MEPOPS) and Office Hours with MaineCare’s Pharmacy Team

Jul 29, 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.

We are entering the next phase of the recovery and are continuing to restore waived edits. On May 1, 2024, Reject-79 Refill Too Soon and Reject-79 Refill Too Soon Carryover were returned to normal functioning. 

The edits below will be restored in a phased manner:

• Starting July 17, 2024, Reject-76 Plan Limitations Exceeded, returned to normal functioning.
  • Claims that have been exceeding limitations like days’ supply, daily dosage, and frequency per day limits will begin to be rejected. 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.

 

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 (www.mainecarepdl.org) is restored with access to Prior Authorization (PA) 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 PAs, may contact the Change Healthcare Optum Pharmacy Helpdesk at MaineHD@optum.com, 1-888-420-9711, or 1-888-445-0497.

MaineCare Pharmacy Service Restoration Office Hours – Thursday, August 01, 2024

For additional support, MaineCare is inviting you to join the next Office Hours call with the MaineCare Pharmacy team on Thursday, August 01, 2024, from 3:30 PM – 4:15 PM related to the current phase of service restoration. We will use this time as an opportunity for sharing questions and concerns and providing technical support from the State. Register in advance for this meeting:

https://mainestate.zoom.us/meeting/register/tZMof-uqpjMvHNF-TfG971ghW71UleSNiPqx