Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)
Chapter II - Specific Policies By Service
Section 144-101-II-80 - Pharmacy Services
Subsection 144-101-II-80.06 - NON-COVERED SERVICES

A. Anorexic, or certain weight loss drugs.

B. Vitamins, vitamin combinations, and herbal products other than those listed on the PDL, except vitamins covered for dialysis and members with quadriplegia and paraplegia or when the criteria in Section 80.05-3 are met, and prenatal vitamins.

C. Hexachlorophene scrubs for nursing facility patients.

D. Products listed as part of the per diem rate of reimbursement in Chapter II, Section 67, "Nursing Facility Services", or as defined in Section 50, "ICF-IID Services", or as defined in Section 60, "Medical Supplies and Durable Medical Equipment", of the MaineCare Benefits Manual or as defined in Attachment A or B of the Agreement between the Department and an assisted living facility.

E. Drugs discontinued or recalled by the manufacturers.

F. Less than Effective Drugs (DESI) as defined by the Food and Drug Administration.

G. Drugs prescribed for TB (these are normally available free of charge from the Maine HHS Public Health's Tuberculosis program). MaineCare coverage is only available after referral from the Maine HHS Public Health and MaineCare prior authorization.

H. Over-the-counter drugs except drugs listed on the Department's designated website.

I. Any drug that is for experimental use or prescribed for indications (other than those approved under OBRA 90 guidelines) or have no Food and Drug Administration (FDA) sanctioned or approved indications; unless there is evidence of two published peer-reviewed placebo-controlled randomized trials and all cost-effective choices for the specific condition have failed.

J. Drugs not covered under OBRA 90 as amended.

K. Drugs prescribed primarily for cosmetic purposes, e.g., Retin-A when used for wrinkles, Rogaine for hair growth.

L. Drugs of manufacturers not participating in the federal Medicaid Rebate program pursuant to 42 U.S.C. § 1396r-8, except certain over-the-counter drugs, enteral and parenteral products and instances where no clinically equivalent drug is available.

M. Fertility drugs.

N. Drugs, Medical Food or nutritional support products prescribed for managing body weight or enhancing nutritional intake when the member is able to eat conventional foods.

O. Agents when used for the symptomatic treatment of cough and cold unless on the Preferred Drug List.

P. Early refills, as detailed in Section 80.07-7.

Q. Drugs used to treat sexual or erectile dysfunction are not covered, unless such drugs are used to treat conditions other than sexual or erectile dysfunction and these uses have been approved by the Food and Drug Administration.

R. Medicare Part D covered drugs for Medicare Part D eligible members.

S. Effective October 1, 2007, prescriptions in written and non-electronic form that are not executed on a tamper-resistant pad, as required by section 1903(i)(23) of the Social Security Act ( 42 USC § 1396b(i)(23)) . Providers must comply with all of the provisions of this Act in order to be appropriately reimbursed