On February 27, MaineCare announced it is now authorizing 30-day prescriptions to continue to assist pharmacies in fulfilling MaineCare member prescriptions in response to the Change Healthcare network interruption. This is a change from MaineCare’s temporary authorization of the use of a three-day override as noted in its February 23 e-message.
The Department will pay all eligible claims submitted once the system is operational. It is working on the details for when and how such payments will be made and will release the details as soon as possible. Change Healthcare has not issued a timeline for resolution yet. The Department will communicate a timeline for resuming normal payments as soon as possible.
Pharmacies should continue to process claims as usual. Pharmacies should check eligibility for MaineCare members during this period by calling MaineCare Provider Services at 1-866-690-5585 or checking the HealthPas online portal.
We are continuing to waive all prior authorization (PA) mandates for pharmacy. With this change to authorize 30-day prescriptions, we expect pharmacies to return to following the MaineCare Preferred Drug List (PDL).
Consistent with state and federal requirements, pharmacies may not bill, demand, or otherwise seek payment from MaineCare members (or a representative of the member) for any MaineCare covered service.
The Department stands ready to assist pharmacies in assessing MaineCare eligibility and facilitating coverage during this extraordinary period and thanks pharmacies and their staff for their help in ensuring access to medications for MaineCare members.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.