Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 104 - MAINE STATE SERVICES MANUAL › Sec2 144-104-3 - Maine Rx Plus Benefit › Subsection 144-104-3.02 - DEFINITIONS

Current through 2024-29, July 17, 2024
3.02-1
Average Wholesale Price
means the wholesale price charged on a specific commodity that is assigned by
				  the drug manufacturer and is listed in a nationally recognized drug pricing
				  file.
3.02-2
Brand Name
				  Drug
is defined as a single-source drug, a cross-licensed drug, or an
				  innovator drug.
3.02-3
Covered Drugs
means drugs that are on the MaineCare Preferred Drug
				  List established by the Department pursuant to its authority to operate the
				  MaineCare program, and revised from time to time, as published on the
				  Department's designated website.
3.02-4
Department
means
				  Department of Health and Human Services.
3.02-5
Generic Drugs
are drugs
				  other than those defined as brand-name drugs.
3.02-6
Initial Discounted Price
for a drug means the amount that MaineCare reimburses pharmacies for any given
				  drug pursuant to Section 80 of the MaineCare Benefits Manual.
3.02-7
Labeler
means an entity
				  or person who receives prescription drugs from a manufacturer or wholesaler and
				  repackages those drugs for later retail sale and who has a labeler code from
				  the Federal Food and Drug Administration under
				  21 CFR
				  §207.20.
3.02-8
Mail Order Pharmacy
is a
				  pharmacy provider that dispenses prescription medications by U.S. mail or
				  private carrier. Mail order pharmacies must have a NABP (National Association
				  of Boards of Pharmacy) provider number uniquely identifying the provider as a
				  mail order pharmacy for purposes of billing. Mail order pharmacies must be
				  licensed by the Maine Board of Pharmacy, enrolled as Medicare and MaineCare
				  providers, and be operating under contract with the Department. Mail order
				  pharmacies must dispense prescription medications from within the United
				  States. Mail order pharmacies must process claims through the State's
				  electronic claims processing system to the standards required by the
				  Department.
3.02-9
Metropolitan Statistical Area (MSA)
is a federal standardized
				  designation using postal zip codes to define rural areas. The Department will
				  define rural by applying MSA/Non-MSA designation to the zip code of the
				  member's residence.
3.02-10
National Drug Code (NDC
) is the identifying number for a drug
				  maintained by the Food and Drug Administration.
3.02-11
Participating Pharmacy
means a pharmacy located in Maine, or another business licensed to dispense
				  prescription drugs in this State, that participates in Maine Rx Plus, and that
				  has signed a Maine Rx Plus provider agreement.
3.02-12
Retail pharmacy
is a
				  pharmacy that possesses a valid outpatient pharmacy license issued by the Board
				  of Pharmacy, accepts Medicare assignment, and which serves Maine Rx Plus
				  participants.
3.02-13
Secondary Discounted Price
means the initial discounted price
				  minus any further discounts paid for out of the Maine Rx Plus dedicated
				  fund.
3.02-14
Telepharmacy
is a method of delivering prescriptions dispensed by a pharmacist to a
				  remote site. Pharmacies using telepharmacy delivery of prescriptions must
				  follow all applicable State and Federal regulations and Maine State Board of
				  Pharmacy rules, including using staff qualified to deliver prescriptions
				  through telepharmacy.