The Board of Pharmacy posted the agenda for its next scheduled meeting on June 6.

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

Office of MaineCare Services provided this notice regarding claims filed by Pharmacy Providers during the outage period (February 21 through March 26). In collaboration with Optum Change Healthcare, Maine has updated the technical instructions to reflect recent feedback received from pharmacy providers about claims denials.

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

Gov. Janet Mills (D) ordered State Offices to be closed on April 4 due to anticipated weather conditions. The Pharmacy board meeting is cancelled. Unless otherwise decided, all matters on the Board’s agenda will be placed on the agenda for the next scheduled meeting on May 2. 

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

The Department of Health and Human Services (DHHS) announced it is expanding interim pharmacy payments to include pharmacies that are part of Maine-based health systems, in response to the continued disruption of MaineCare’s pharmacy claims due to the national cyber security issue with Change Healthcare. The amount of the interim payment for these Maine health system-based pharmacies will equal 75% of the average weekly MaineCare reimbursement to each qualifying pharmacy before the disruption. The payments already in place for independent and safety net pharmacies will continue to equal 100% of the average weekly MaineCare reimbursement amount from before the disruption, as these pharmacies are more dependent on MaineCare pharmacy revenue to continue ongoing operations.

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

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.

On February 22, MaineCare announced it is experiencing intermittent network issues processing claims due to Change Healthcare network interruption. As a result, if a pharmacy experiences issues with claims, MaineCare advises to follow routine offline claims processing procedures.

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

On February 12, the Department of Health and Human Services updated its standing order regarding COVID-19 at home tests. The Standing Order authorizes licensed pharmacists to create a prescription for the over-the-counter (OTC) COVID-19 at home tests for eligible MaineCare members.

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

The state legislature held two work sessions on LD 1829, An Act to Reduce Prescription Drug Costs by Requiring Reference-based Pricing. The measure attempts to prohibit the dispensing, delivery or administration of a prescription drug at a cost that exceeds the maximum fair price during the price applicability period. The bill also attempts to prohibit insurers from purchasing or seeking reimbursement for referenced drugs at a cost higher than the maximum fair price. Lastly, LD 1829 attempts to prohibit retail pharmacies from purchasing or seeking reimbursement for referenced drugs dispensed to a consumer whose health care is provided by an insurer at a cost exceeding the maximum fair price. The bill is still pending before the Committee on Health Coverage, Insurance and Financial Services. NACDS joined other industry groups in a letter of concern with opposition to several aspects of the bill. 

Also in Maine, on February 1, the Board of Pharmacy held its regularly scheduled meeting.  

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

On January 4, the Maine Board of Pharmacy held its regular meeting. The agenda included the following: 

• Access to HIV Prevention Medications (PL 2021 Ch 265), including PEP and PrEP Protocols 
• Access to Birth Control by Making Certain Contraception Accessible from a Pharmacist (PL 2023 Ch 115)  
• Authorize Vaccine Administration by Pharmacy Technicians and Reduce Vaccine Administration Training Requirements for Pharmacists (PL 2023 Ch 245)  
• Board Rule Chapter Amend Limits on Medication in Vending Machines (PL 2023 Ch 160)  
• Pharmacists Dispense an Emergency Supply of Chronic Maintenance Drugs (PL 2023 Ch 566) – Update  
• Telehealth Rulemaking Status – Update  

Also in Maine, on January 11, Gov. Janet Mills (D) issued a State of Emergency declaration. The State of the Civil Emergency will last one week, and the Governor will continue to evaluate its necessity daily. This declaration triggers the hazard pay provision for the City of Portland for those with operations within the city. 

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.