Maine § 22 §3174-M Medicaid drug formulary

Maine Statutes

§ 22 §3174-M — Medicaid drug formulary

Maine·Title 22 HEALTH AND WELFARE·Part 1 ADMINISTRATION·Ch. 855 AID TO NEEDY PERSONS

1.Authority. The department has the authority to determine which prescription and over-the-counter drugs are subject to reimbursement and coverage under the Medicaid program. 1-A. Formulary standards. Any formulary established by the department must:

2.Drug formulary committee. 2-A. Drug formulary committee. As authorized by Section 1927 (d) (4) (A) of the federal Social Security Act, 42 United States Code, Section 1396r‑8, the department may develop a formulary using the department's MaineCare drug utilization review committee, except that the membership of the formulary committee must include pharmacists who are expert in pharmacotherapy for pediatric, geriatric and psychiatric populations.

3.Emergency supply. The department shall adopt routine technical rules as necessary that provid

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1.
Authority.
The department has the authority to determine which prescription and over-the-counter drugs are subject to reimbursement and coverage under the Medicaid program.
1-A.
Formulary standards.
Any formulary established by the department must:
2.
Drug formulary committee.
2-A.
Drug formulary committee.
As authorized by Section 1927 (d) (4) (A) of the federal Social Security Act, 42 United States Code, Section 1396r‑8, the department may develop a formulary using the department's MaineCare drug utilization review committee, except that the membership of the formulary committee must include pharmacists who are expert in pharmacotherapy for pediatric, geriatric and psychiatric populations.
3.
Emergency supply.
The department shall adopt routine technical rules as necessary that provide for a pharmacy to dispense, in accordance with applicable licensing standards and professional judgment, a one-time supply for 10 days of the prescribed drug. The rules must allow the department to authorize refills of the drug on a case-by-case basis at the end of the 10-day period if the prescribing provider has not submitted the required information at that time or the department determines that an additional refill is necessary.
4.
Rulemaking.
Rules adopted pursuant to section 3174‑J prior to its repeal are effective as of the effective date of this chapter without the taking of any action pursuant to the Maine Administrative Procedure Act.
5.
Expedited review process.
The department shall provide an independent review process whenever a MaineCare member has written certification from the member's physician that:

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Legislative History

RR 1993, c. 1, §53 (RNU). PL 1993, c. 410, §I10 (NEW). PL 2005, c. 386, §§X1-5 (AMD). PL 2005, c. 519, §DDDD1 (AMD). PL 2005, c. 519, §DDDD3 (AFF). PL 2021, c. 265, §§1-3 (AMD). PL 2021, c. 265, §8 (AFF).