Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 104 - MAINE STATE SERVICES MANUAL
Sec2 144-104-4 - Maine Part D Wrap Benefits
Appendix 144-104-A - MAINE PART D WRAP BENEFITS COVERAGE CHART

Universal Citation: 10 ME Code Rules ยง 144-104-A
Current through 2024-38, September 18, 2024

Eligibility Group Co-Payment Premiums Deductible Gap Part D Excluded Drugs*
Dual Eligibles Residing in Nursing Facilities N/A N/A N/A N/A Covered as reimbursed under Maine Care Benefits Manual, Chapter II, Section 80 P harmacy Services
Dual Eligibles residing in Assisted Living and Level I, II, III and IV PNMI Eligibles (as reimbursed under Maine Care Benefits Manual, Chapter III, Appendices C and F, Section 97, Private Non-Medical Institution Services), or who are co-pay exempt under Chapter 1, Section 1.09-2 of the Maine Care Benefits Manual. 100% of all co-payments N/A N/A N/A Covered as reimbursed under Maine Care Benefits Manual, Chapter II, Section 80 P harmacy Services
All other Dual Eligibles 50% of the cost of Brand Name drugs with a cap of $10 per prescription, and 100% of the cost of generics up to $2.50. N/A N/A N/A Covered as reimbursed under Maine Care Benefits Manual, Chapter II, Section 80 P harmacy Services
Medicare Savings Program DEL Eligibles (QMB, SLMB, QI) 50% of the cost of Brand Name drugs with a cap of $10 per prescription, and up to $2.50 per generic. N/A N/A N/A Covered as paid under Chapter 104, Section 2, DEL Policy
DEL members eligible for Medicare Part D Not covered 100% of Part D Premiums 50% of the Part D deductible Members will have co-pay of 20% plus $2. Covered as paid under Chapter 104 DEL Policy
*Please see the following website for a list of covered Part D excluded drugs: www.Maine Carepdl.org (under "General Pharmacy Info")

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