C.M.R. 10, 144, ch. 104, § 144-104-4, subsec. 144-104-4.05
As detailed in Chapter 104, Section 2, the DEL benefit is limited to drugs of manufacturers that have both a valid rebate agreement with the federal government pursuant to 42 U.S.C. § 1396r-8 and a DEL Rebate Agreement. The Maine Part D Wrap Benefit additionally allows coverage of drugs of manufacturers that may not have both a valid DEL and federal rebate agreement. Drugs may be subject to prior authorization and the step order as set forth in Chapter 104, Section 2. The Department may refuse coverage for a drug when the prescriber cannot demonstrate medical necessity.
See the chart in Appendix A for a summary of Covered Benefits under this Section.
The Department may require prior authorization for certain drugs in this benefit, and follows guidelines as set forth in Chapter 104, Section 2.
In order to facilitate appropriate utilization, the Department utilizes the Preferred Drug List as detailed in Chapter 104, Section 2.
C.M.R. 10, 144, ch. 104, § 144-104-4, subsec. 144-104-4.05