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
Specialty Drug List 2022Q2 289.14 KB 2022/07/06
Important Billing Information for Maine RX COVID 169.28 KB 2021/07/02
Synagis Season Update 117 KB 2021/03/03
Enrolled Pharmacy List as of 06042020 143.52 KB 2020/07/24
Maintenance List as of 04.18.2019 1.34 MB 2019/07/11
MaineCare Abilify Splitting Table 56.93 KB 2019/02/19
Pharmacy Notice 2019 Plan Changes 44.86 KB 2018/10/05
Morphine Sulfate Equivalent (MSE) Chart 211.81 KB 2018/02/05

CMS Rebatable List

Name Description Date
CMS Rebatable Drug List 1Q2022 6.83 MB 2022/07/08
CMS Rebatable Drug List 2Q2021 8.49 MB 2021/08/16
CMS Rebatable Drug List 1Q2021 6.64 MB 2021/08/06
CMS Rebatable Drug List 1Q2020 6.42 MB 2020/06/23
CMS Rebatable Drug List 3Q2019 6.37 MB 2020/01/16
CMS Rebatable Drug List 2Q2019 6.37 MB 2019/10/29
CMS Rebatable Drug List 1Q2019 6.28 MB 2019/07/18

Memos and Mailings

Name Description Date
Provider Newsletter August 2 2022 PDL Update 142.99 KB 2022/08/02
Requiring Prescriber Enrollment 111.96 KB 2022/06/20
Provider Newsletter April 8 2022 PDL Update 145.61 KB 2022/04/11
End of Atypical Inter-Season palivizumab coverage 119.4 KB 2022/03/08
Pharmacy Updates: Varenicline and NPH Newsletter 179.14 KB 2022/02/24
REMINDER: Standing Order for Dispensing COVID OTC Test Kit 155.78 KB 2022/02/07
Provider Newsletter January 14 2022 PDL Update 166.28 KB 2022/01/14
Buprenorphine Pregnancy Memo 94.39 KB 2022/01/13
Pharmacy Benefit Update Winter 2021 144.84 KB PDL Changes will be effective January 1, 2022 2021/12/23
Pharmacy Communication: Pharmacy Store Hours 164.27 KB 2021/12/20
Standing Order for Dispensing COVID OTC Test Kit 151.6 KB 2021/12/13
Provider Newsletter November 2021 PDL Update 175.41 KB 2021/12/09
Important Billing Information for COVID SCC10 179.29 KB 2021/12/09
Maine General Assistance Billing Reminder 108.9 KB 2021/11/23
Important 3rd dose Billing Information for COVID-19 Vaccines 178.56 KB 2021/09/09
Provider Newsletter July 2021 PDL Update 167.52 KB 2021/07/22
Prior Authorization Criteria for Buprenorphine 173.45 KB 2021/07/19
Important Billing Information for COVID-19 Vaccines- ages 12-15 98.03 KB 2021/05/14
Provider Newsletter April 2021 PDL Update 182.29 KB 2021/04/02
Provider Newsletter- Pharmacy NPI 161.78 KB 2021/04/01
Important Billing Information for COVID 228.72 KB 2021/03/04
Provider Newsletter January 2021 PDL Update 200.85 KB 2021/01/29

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