Pharmacy Providers May Not Refuse Services to a MaineCare Member for Failure to Pay a Copayment

Nov 13, 2024

On September 16, 2024, MaineCare sent a message advising pharmacies that copays for pharmacy services would resume effective October 1, 2024, in conjunction with the end of the American Rescue Plan Act (ARPA). Follow up messages were also sent on September 27, 2024 and September 30, 2024.   

Pursuant to MaineCare Benefits Manual Ch 1 Section 1.09-1(B), no provider may deny services to a member for failure to pay a copayment. 

As a reminder, effective October 1, 2024: 

• MaineCare reinstates copayments for Section 80: Pharmacy Services 

• MaineCare no longer covers over the counter COVID-19 tests 

• The federal government is supplying four free COVID-19 test kits by visiting this website: https://aspr.hhs.gov/COVID-19/Test/Pages/default.aspx 

• The COVID-19 vaccine administration fee through the pharmacy benefit returns to $5.00 

For questions, please contact Provider Relations Specialist Shannon Beggs.