Provider Help Desk: (p) 888-420-9711 (f) 800-408-1088 | Member Help Desk: (p) 866-796-2463 (f) 207-287-8601
Prior Authorization (PA) Helpdesk (for Provider PA inquiries): (p) 888-445-0497 (f) 888-879-6938

PA Intro

Listed below are all the PA forms you will need in order to request drugs that require prior authorization.

MaineCare Preferred Drug List

To submit a request:

  1. Select and print the proper form from the list below
  2. Fill out the form completely
  3. Fax the completed form to us at 1-888-879-6938
  4. OR

    Log in to the MaineCare Rx Portal @ and submit PA's electronically

For answers to frequently asked questions and additional information on submitting a PA:  PA Submission Instructions

(Please note - If the PA form asks for supporting medical documentation, please fax this information along with the completed PA form.)

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