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
Subsection 144-104-4.05 - BENEFITS
Current through 2024-38, September 18, 2024
As detailed in Chapter 104, Section 2, the DEL benefit is limited to drugs of manufacturers that have both a valid rebate agreement with the federal government pursuant to 42 U.S.C. § 1396r-8 and a DEL Rebate Agreement. The Maine Part D Wrap Benefit additionally allows coverage of drugs of manufacturers that may not have both a valid DEL and federal rebate agreement. Drugs may be subject to prior authorization and the step order as set forth in Chapter 104, Section 2. The Department may refuse coverage for a drug when the prescriber cannot demonstrate medical necessity.
4.05-1 Covered Benefits
See the chart in Appendix A for a summary of Covered Benefits under this Section.
4.05-2 Prior Authorization (PA)
The Department may require prior authorization for certain drugs in this benefit, and follows guidelines as set forth in Chapter 104, Section 2.
4.05-3 Preferred Drug List
In order to facilitate appropriate utilization, the Department utilizes the Preferred Drug List as detailed in Chapter 104, Section 2.
