Some Other Important Facts
About Prescription Drug Coverage
- Eligibility for the Low Cost Drug Program is based on income. Any assets you have will not affect your
- The so-called "Estate Recovery Law" does not
apply to the Low Cost Drug Program or Maine Rx Plus.
- If you meet the income and asset guidelines, full benefit MaineCare (formerly Medicaid and Cub Care) provides full
prescription drug coverage. Some people need to pay a small co-payment
of $3.00 per prescription (with a cap of $30 per month, per
person. If you are also enrolled in Medicare, you will get most of your
drugs through Medicare Part D and the co-pays will be
different. Read more on Medicare Part D
To get an application for full benefit MaineCare, call the Maine Department of Health and Human Services
at 1-866-796-2463 begin_of_the_skype_highlighting 1-866-796-2463 end_of_the_skype_highlighting or your local DHHS office. You can also call the Consumers for Affordable Health Care HelpLine at 1-800-965-7476 begin_of_the_skype_highlighting 1-800-965-7476 end_of_the_skype_highlighting for
information and assistance. Seniors (age 60 and older) and people with disabilities can call the
Maine Legal Services for the Elderly HelpLine at 1-800-750-5353 begin_of_the_skype_highlighting 1-800-750-5353 end_of_the_skype_highlighting.
Prior Approval Of Prescription Drugs
Some prescription drugs you get through the Low Cost Drug
Program must be "prior approved" by DHHS in order to
be covered. DHHS has a list of
expensive drugs for which they think there is a cheaper alternative that
can treat you just as well. You can only get coverage
for the more expensive drug with DHHS's "prior approval." If you and
your doctor think the more expensive drug is best
for you, your doctor must request approval from DHHS (by fax) and
provide information supporting that request. If DHHS approves, you
will be able to get that drug under the Low Cost Drug Program with no
Q. How long does DHHS have to make a decision on my doctor's request for "prior approval" of a drug?
A. DHHS must grant or deny your doctor's request for prior authorization within 24 hours of the time it receives
doctor's completed request for "prior approval" of a particular drug.
Q. What happens if I get to the pharmacy and can't get my prescription?
A. If you can't get your prescription at the pharmacy,
ask the pharmacist why you can't get your medicine.
If you can't get your medicine because your doctor did not file
paperwork for prior authorization, contact your doctor right
away to discuss your options. If you cannot reach your doctor, you may
be given a 96-hour (4-day) supply of
most drugs without prior authorization. Whether or not you get this
supply is up to the pharmacist. If the pharmacist does not know
why your prescription was denied, you can call the MaineCare pharmacy
Help Desk at 1-866-796-2463 begin_of_the_skype_highlighting 1-866-796-2463 end_of_the_skype_highlighting.
Q. How long does the prior approval last?
A. Up to one year. After a year, your doctor will have to ask for prior approval again.
Q. What if I am denied prior approval?
A. You can first try to resolve the dispute by contacting DHHS at 1-866-RxMaine begin_of_the_skype_highlighting 1-866-RxMaine end_of_the_skype_highlighting (1-866-796-2463 begin_of_the_skype_highlighting 1-866-796-2463 end_of_the_skype_highlighting). If you
still disagree, you may request a fair hearing. If you are deaf and have a TYY machine, call the same number.
You Have A Right To A Fair Hearing. If you disagree with
a decision of DHHS regarding drugs, you have a right to
request a "fair hearing" to have that decision reviewed by an impartial
person. You have a right to be represented at that
hearing by a person of your choice. Call or write the Office of
Administrative Hearings, DHHS, 11 State House Station, Augusta, Maine
04333-0011; phone: (207) 287-3610 begin_of_the_skype_highlighting (207) 287-3610 end_of_the_skype_highlighting. To keep your medicine during an appeal, you must appeal within 10 days of the denial.
Who To Call For Help. If you have questions about the Low Cost Drug Program call the Consumers for Affordable Health Care
HelpLine at 1-800-965-7476 begin_of_the_skype_highlighting 1-800-965-7476 end_of_the_skype_highlighting, or for:
- People with disabilities: the Disability Rights
Center at 1-800-452-1948 begin_of_the_skype_highlighting 1-800-452-1948 end_of_the_skype_highlighting (or in the Augusta area 626-2774)
- People age 60 and over:
Legal Services for the Elderly at 1-800-750-5353 begin_of_the_skype_highlighting 1-800-750-5353 end_of_the_skype_highlighting (or in the Augusta area 623-1797)
To find out which drugs require prior authorization, go to the
Preferred Drug Lists.