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

If you cannot view a file, please download the appropriate free plug-in from the links below.

Name Description Date
Specialty Drug List 543.39 KB 2022/02/15
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 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
CMS Rebatable Drug List 4Q2018 6.24 MB 2019/04/18
CMS Rebatable Drug List 3Q2018 6.21 MB 2019/01/15
CMS Rebatable Drug List 2Q2018 6.12 MB 2018/11/12
CMS Rebatable Drug List 1Q2018 810.8 KB 2018/06/15

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