Maine.gov
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

General Pharmacy Info

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Name Description Date
Pharmacy List by NPI 344.34 KB 2017/10/04
Pharmacy List by Name 344.48 KB 2017/10/04
Morphine Sulfate Equivalent (MSE) Chart 50.37 KB 2016/11/18
MaineCare PDL Splitting Tables 69.12 KB 2011/07/22

CMS Rebatable List

Name Description Date
CMS Rebatable Drug List 1Q2017 768.68 KB 2017/06/13
CMS Rebatable Drug List 2Q2016 816.74 KB 2016/10/25
CMS Rebatable Drug List 3Q2015 783.64 KB 2016/02/16
CMS Rebatable Drug List 4Q2015 799.9 KB 2016/02/16
CMS Rebatable Drug List 2Q2015 777.28 KB 2015/08/24
CMS Rebatable Drug List 1Q2015 11.07 MB 2015/05/15
CMS Rebatable Drug List 4Q2014 11 MB 2015/05/07
CMS Rebatable Drug List 3Q2014 11.25 MB 2015/05/05
CMS Rebatable Drug List 2Q2014 1.52 MB 2014/08/18
CMS Rebatable Drug List 4Q2013 11.04 MB 2014/02/18
CMS Rebatable Drug List 1Q2013 673.85 KB 2014/01/23
CMS Rebatable Drug List 3Q2013 716.18 KB 2013/11/18
CMS Rebatable Drug List 2Q2013 725.69 KB 2013/08/23

Memos and Mailings

Name Description Date
Vyvanse/ Adderall Provider Newsletter 88.05 KB 2017/06/22
Pharmacy Newsletter COB Information 202.83 KB 2017/06/22
Provider Newsletter May 2017 PDL Changes 87.65 KB 2017/05/01
Provider Newsletter March 2017 PDL Changes 83.12 KB 2017/03/10
DEA Validation Implementation and Clarification Memo 219.35 KB 2017/02/16
MaineCare Pharmacy Newsletter 151.12 KB MaineCare Pharmacy Criteria Regarding PL 488 2017/01/12
Pharmacy Benefit Update Fall/Winter 2016 249.33 KB 2016/12/20
Provider Newsletter October 2016 PDL Changes 121.34 KB 2016/10/06
Provider Newsletter September 2016 PDL Changes 205.42 KB 2016/08/30
Provider Newsletter May 2016 PDL Changes 119.53 KB 2016/05/24
Methadone Update 277.36 KB 2016/04/26
Provider Newsletter March 2016 PDL Changes 123.57 KB 2016/03/11
Provider Newsletter January 29 2016 PDL Changes 202.63 KB 2016/02/01
Pharmacy Benefit Update Fall/Winter 468.72 KB 2015/12/31
Provider Newsletter for LD-91 120.17 KB 2015/10/13
Provider Newsletter July PDL Changes 128.28 KB 2015/07/23
Provider Newsletter April PDL Changes 124.85 KB 2015/04/17
Provider Newsletter PDL Changes Effective January 1, 2015 105.63 KB 2014/12/30
Provider Newsletter August PDL Changes 45.4 KB 2014/09/02
Provider Newsletter May PDL Changes 73.97 KB 2014/05/29
Pharmacy Benefit Update Spring 2014 152.57 KB 2014/05/29
Provider Newsletter April PDL Changes 78.16 KB 2014/04/10
Provider Notice D0 COB 3 Update 300.28 KB 2014/03/31
MaineCare 15 Day Initial Script Limit Update 73.37 KB 2014/03/21
Maine MEDICAID COB 3 Go LIVE Notice 199.34 KB 2014/03/21
Provider Registration Notice 43 KB 2014/02/17
Maine Medicaid Pilot Testing Notification 158.86 KB 2014/02/10
Provider Notice D0 COB 3 Changes 203.43 KB Informational Letter 2014/02/04

Forms

Name Description Date
Reversal Form 21.81 KB 2014/08/28
MEPARTD Manual Claim Form NCPDP D.0 168 KB 2014/04/29
MEPOP Manual Claim Form NCPDP D.0 168 KB 2014/04/29
ME Compound Manual Claim form NCPDP D.0 168.08 KB 2014/04/29
BMS012 Form 64.22 KB 2010/12/23

Maine Rx Plus

Name Description Date
MaineRx Plus Pharmacy List by NABP 135.84 KB 2010/03/05
MaineRx Plus Pharmacy List by NPI 135.84 KB 2010/03/05
MaineRx Plus Pharmacy List by NAME 135.91 KB 2010/03/05