Biosimilar Preferred Drug List (PDL) 

May 16, 2022

Through adoption of MaineCare Benefits Manual Chapter II, Section 90.04-7(B), Biosimilar Preferred Drug List, and pursuant to P.L. 2021, Ch. 398, Sec. A-17, An Act Making Unified Appropriations and Allocations for the Expenditures of State Government, General Fund and Other Funds and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2021, June 30, 2022 and June 30, 2023, the Department is implementing a Biosimilar Preferred Drug List (PDL). The Biosimilar PDL establishes preferred and non-preferred Physician-Administered Drugs (PADs). Preferred drugs are available without a Prior Authorization (PA).  Providers must try preferred drugs first. 

Non-preferred drugs require a PA. PA forms are available on the Health PAS Online Portal.   For the Department to consider approving  a non-preferred drug, the provider must include with their PA request documentation of preferred drug failure due to lack of efficacy, intolerable side effects to the preferred drug, or clinical exceptions.  Clinical exceptions include the presence of a condition that prevents usage of the preferred drug or a significant drug interaction between another drug and the preferred drug.   

Please contact your Provider Relations Specialist, Tia Bolduc, with questions.