Coverage of Medications for Treatment of Opioid Use Disorder in Pregnancy

Jun 23, 2023

MaineCare covers brand name Suboxone film and generic buprenorphine/naloxone tablets as “Preferred” covered products for treatment of opioid use disorder (OUD) as they are the most cost-effective forms of treatment on the MaineCare Preferred Drug List (PDL). Providers may choose to prescribe buprenorphine/naloxone combination product or buprenorphine monotherapy for patients who are pregnant.      

Buprenorphine monotherapy is covered for pregnant patients without a prior authorization (PA) when pregnancy is indicated either in eligibility or on the prescription. If the member is newly pregnant and eligibility does not yet indicate pregnancy status, please utilize the following guidance:   

• Enter “P” or “07” in the diagnosis field if the prescriber indicates on the prescription that the patient is pregnant.    

• Neither a PA nor an override from Change Healthcare is required in this situation.      

If you have any questions or need assistance, please call the Change Healthcare Pharmacy Help Desk at 1-888-420-9711.