These publications are made available on the Office of MaineCare’s website as a public service. Although the Office of MaineCare Services makes an effort to provide accurate information, portions of text available may be incorrect or not current. Its accuracy is not certified by the Office of MaineCare Services, Maine Department of Health and Human Services or the State of Maine. The State, its agencies, officers and employees do not make any statutory, express or implied representation or warranty about the accuracy, reliability, completeness or timeliness of any information available and disclaim any liability for any losses resulting from any person’s reliance on such information. Any person relying on information contained within the text does so at the person’s own risk.
| Name | Description | Date |
|---|---|---|
| Maine Part D Co-pay and Plan Changes Effective January 1, 2022 161.89 KB | 2021/12/28 | |
| Maine Part D 2019 Changes 42.27 KB | 2018/10/05 | |
| Maine Part D 2018 Changes 23.66 KB | 2017/10/06 | |
| Maine Part D 2017 Changes 28.55 KB | 2016/10/14 | |
| Maine Part D 2016 Changes 28.07 KB | 2015/11/06 | |
| Maine Part D Co-pay and Plan Change Effective 01/01/15 28.08 KB | 2014/11/03 | |
| Maine Part D Changes Effective 01/01/2013 13.13 KB | 2012/10/31 | |
| Maine Part D Co-pay and Plan Change Effective 01/01/12 55.17 KB | 2012/01/03 | |
| MEPARTD Co-Pay and Plan Changes Effective 01/01/11 57.47 KB | 2010/12/20 | |
| MEPARTD Co-pay and Plan Changes Effective 01/01/10 62.42 KB | 2010/11/24 | |
| Plan Change 01/03/2008 26.5 KB | 2008/01/04 | |
| S5617 Formulary PA Criteria 2007 363.94 KB | 2007/04/03 | |
| Prior Authorization Criteria and Guidelines 2007 4-Tier 649 KB | 2007/04/03 | |
| Prior Authorization Criteria and Guidelines 2007 3-Tier 625 KB | 2007/04/03 | |
| Maine CS Requirements 231.5 KB | 2007/04/03 |
| Name | Description | Date |
|---|---|---|
| Medicare Part D Supplemental Form 40.73 KB | 2011/04/28 | |
| Part B/D Combo Claim Form 90 KB | 2008/10/20 |
| Name | Description | Date |
|---|---|---|
| Celebrex 124.59 KB | 2007/04/03 | |
| Provigil 35.52 KB | 2007/04/03 | |
| Diflucan 50.25 KB | 2007/04/03 | |
| Rebetol 130.6 KB | 2007/04/03 | |
| Elidel 83.64 KB | 2007/04/03 | |
| Rebetron 131.88 KB | 2007/04/03 | |
| Expedited Formulary Exception Request Form 69.33 KB | 2007/04/03 | |
| Regranex 38.43 KB | 2007/04/03 | |
| Expedited Redetermination Request Form 63.28 KB | 2007/04/03 | |
| Retinoid 36.26 KB | 2007/04/03 | |
| Formulary Exception Request Form 72.96 KB | 2007/04/03 | |
| Roferon 38.01 KB | 2007/04/03 | |
| Forteo 52.19 KB | 2007/04/03 | |
| Standard Redetermination request Form 28.69 KB | 2007/04/03 | |
| Fuzeon 93.22 KB | 2007/04/03 | |
| Strattera 38.3 KB | 2007/04/03 | |
| Growth Hormones 37.33 KB | 2007/04/03 | |
| Tier Exception Request Form 36.92 KB | 2007/04/03 | |
| Hematopoietic Agent 128.1 KB | 2007/04/03 | |
| Zelnorm 36.59 KB | 2007/04/03 | |
| Hepatitis B Vaccine 51.2 KB | 2007/04/03 | |
| Zofran 35.96 KB | 2007/04/03 | |
| Humira 62.24 KB | 2007/04/03 | |
| IntronA 43.13 KB | 2007/04/03 | |
| Lotronex 51.91 KB | 2007/04/03 | |
| Multiple Sclerosis 39.08 KB | 2007/04/03 | |
| Alzheimers 62.31 KB | 2007/04/03 | |
| Miscellaneous 36.24 KB | 2007/04/03 | |
| Amphetamine Products 53.88 KB | 2007/04/03 |
| Name | Description | Date |
|---|---|---|
| General PA Form 101.6 KB | 2007/08/07 |
| Name | Description | Date |
|---|---|---|
| Medicare DER Form 73.57 KB | 2007/04/03 | |
| Injectible 64.53 KB | 2007/04/03 | |
| Model Coverage Determination Request Form 243.43 KB | 2007/04/03 | |
| Redetermination 246.47 KB | 2007/04/03 | |
| PDP Appeal Request 31 KB | 2007/04/03 |
| Name | Description | Date |
|---|---|---|
| Medication Prior Authorization Request Form 22.89 KB | 2007/04/03 | |
| AARP_CMS Model PartD Exception and Prior Authorization Form 30.38 KB | 2007/04/03 |
| Name | Description | Date |
|---|---|---|
| Appeal Request Form 131.69 KB | 2007/04/03 |
| Name | Description | Date |
|---|---|---|
| AARP Pharmacy NetworkFiles 90 KB | 2007/08/07 | |
| AARP Formulary 6.21 MB | 2007/08/07 |
| Name | Description | Date |
|---|---|---|
| Reconsideration 253.74 KB | 2007/04/03 |