Pharmacy Services

Change Healthcare Pharmacy Website

Visit the Change Healthcare’s Pharmacy website for: 

  • Preferred Drug Lists - Pharmacy, Diabetic Supply, and Over the Counter Rebate lists
  • Drug Utilization Review (DUR) meeting schedule, agendas, and minutes 
  • BIN & PCN list for MaineCare Pharmacy claims processing 
  • State of Maine Maximum Allowable Costs (SMAC) lists and Dispute Form 

Pharmacy Prior Authorization (PA) and Claims Denials

Enroll to Avoid PA and Prescription Drug Denials

Billing providers must include the National Provider Identifier (NPI) of an enrolled MaineCare practitioner who is ordering, prescribing, or referring on all claims submitted to MaineCare. This is a federal requirement.

MaineCare will begin to deny pharmacy prior authorizations for prescriptions written by providers who are not enrolled with MaineCare, and will subsequently begin to deny Point of Sale pharmacy claims that do not have the NPI of an enrolled prescriber on the claim. 

PA and Claims Impacted 

This requirement is for: 

  • All prescription claims, including Point of Sale claims 

  • Clinical laboratories for ordered tests  

  • Imaging centers for ordered imaging procedures  

  • Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) 

Enroll with MaineCare today!   

Make sure your patients can continue to get their medications covered by ensuring any unenrolled prescribing providers complete an online application through the MaineCare Partner Portal. Providers that do not plan to seek MaineCare reimbursement may continue prescribing medications to MaineCare members by enrolling specifically as a Non-Billing, Ordering, Prescribing or Referring (NOPR) provider, which is a shorter process. The NOPR enrollment is faster and requires less documentation than a regular MaineCare enrollment – and is free to complete. 

We encourage unenrolled prescribers to start by visiting the Provider Enrollment & Revalidation webpage for helpful resources to guide you through the enrollment process. 

Non-Ordering, Prescribing and Referring Provider (NOPR) Enrollment Requirements

Standing Orders

Non-Prescription Oral Contraceptive Products 

This Standing Order (PDF) authorizes licensed pharmacists to create a prescription for and dispense medically appropriate oral contraceptive products to eligible MaineCare members.

Naloxone 

This Standing Order (PDF) authorizes licensed pharmacists to create a prescription for and dispense naloxone nasal spray products to eligible MaineCare members.

Nicotine Replacement Therapy (NRT) Products

This Standing Order (PDF) authorizes licensed pharmacists to dispense medically appropriate NRT products to eligible MaineCare members who require the products for help with smoking cessation or vaping cessation.

Medications for Treatment of Opioid Use Disorder (MOUD)

See the following documents for guidance about the Prior Authorization (PA) process for Buprenorphine:

February 21, 2024 - March 26, 2024 - Disruption of MaineCare Pharmacy Claims due to Cybersecurity