Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL) › Chapter II - Specific Policies By Service › Section 144-101-II-80 - Pharmacy Services › Subsection 144-101-II-80.06 - NON-COVERED SERVICES

Current through 2024-29, July 17, 2024
MaineCare does not reimburse for the following drugs or
						products as drugs:
A. Anorexic, or
					 certain weight loss drugs.
B.
					 Vitamins, vitamin combinations, and herbal products other than those listed on
					 the PDL, except vitamins covered for dialysis and members with quadriplegia and
					 paraplegia or when the criteria in Section 80.05-3 are met, and prenatal
					 vitamins.
C. Hexachlorophene scrubs
					 for nursing facility patients.
D.
					 Products listed as part of the per diem rate of reimbursement in Chapter II,
					 Section
					 67, "Nursing Facility Services",
					 or as defined in Section 50, "ICF-IID Services", or as defined in Section
					 60, "Medical Supplies and Durable
					 Medical Equipment", of the
MaineCare Benefits Manual
or as
					 defined in Attachment A or B of the Agreement between the Department and an
					 assisted living facility.
E. Drugs
					 discontinued or recalled by the manufacturers.
F. Less than Effective Drugs (DESI) as
					 defined by the Food and Drug Administration.
G. Drugs prescribed for TB (these are
					 normally available free of charge from the Maine HHS Public Health's
					 Tuberculosis program). MaineCare coverage is only available after referral from
					 the Maine HHS Public Health and MaineCare prior authorization.
H. Over-the-counter drugs except drugs listed
					 on the Department's designated website.
I. Any drug that is for experimental use or
					 prescribed for indications (other than those approved under OBRA 90 guidelines)
					 or have no Food and Drug Administration (FDA) sanctioned or approved
					 indications; unless there is evidence of two published peer-reviewed
					 placebo-controlled randomized trials and all cost-effective choices for the
					 specific condition have failed.
J.
					 Drugs not covered under OBRA 90 as amended.
K. Drugs prescribed primarily for cosmetic
					 purposes, e.g., Retin-A when used for wrinkles, Rogaine for hair
					 growth.
L. Drugs of manufacturers
					 not participating in the federal Medicaid Rebate program pursuant to
					 42 U.S.C. §
												1396r-8, except certain over-the-counter
					 drugs, enteral and parenteral products and instances where no clinically
					 equivalent drug is available.
M.
					 Fertility drugs.
N. Drugs, Medical
					 Food or nutritional support products prescribed for managing body weight or
					 enhancing nutritional intake when the member is able to eat conventional
					 foods.
O. Agents when used for the
					 symptomatic treatment of cough and cold unless on the Preferred Drug
					 List.
P. Early refills, as detailed
					 in Section 80.07-7.
Q. Drugs used
					 to treat sexual or erectile dysfunction are not covered, unless such drugs are
					 used to treat conditions other than sexual or erectile dysfunction and these
					 uses have been approved by the Food and Drug Administration.
R. Medicare Part D covered drugs for Medicare
					 Part D eligible members.
S.
					 Effective October 1, 2007, prescriptions in written and non-electronic form
					 that are not executed on a tamper-resistant pad, as required by section
					 1903(i)(23) of the
Social Security Act
(
					 42 USC §
												1396b(i)(23) ). Providers
					 must comply with all of the provisions of this Act in order to be appropriately
					 reimbursed