Chapter 539
H.P. 1651 - L.D. 2289
PART TT
Sec. TT-1. Prescription drugs under the MaineCare childless adult waiver. This section applies to the provision of prescription drugs under the MaineCare childless adult waiver.
1. Waiver application. The Department of Health and Human Services, Office of MaineCare Services shall submit an amendment to the federal Centers for Medicare and Medicaid Services for the Medicaid waiver for childless adults to establish a different preferred drug list for MaineCare members who are enrolled in the childless adult waiver. The different preferred drug list must provide for:
A. Coverage of brand-name prescription drugs for which there is no suitable generic and therapeutically equivalent drug available, such as for the treatment of HIV or Hepatitis B;
B. Use of a variant of the 5-brand limit on brand-name prescription drugs established pursuant to the Maine Revised Statutes, Title 22, section 3174-FF, subsection 3, paragraph H, subparagraph (3) that provides for drug classes when generic and therapeutically equivalent drugs are available. Once the waiver is granted, the department is authorized to implement the different preferred drug list notwithstanding that it is more restrictive than the 5 brand-name limitation contained in Title 22, section 3174-FF, subsection 3, paragraph H, subparagraph (3); and
C. Modification of the prior approval process to tighten the criteria for allowable prescription drugs.
2. Other provisions. Provisions in addition to those in subsection 1 regarding the MaineCare childless adult waiver are as set out in this subsection.
A. The Department of Health and Human Services, Office of MaineCare Services shall undertake an initiative to identify on the membership card of an enrollee in the childless adult waiver the enrollment of that person in the waiver. The department shall begin this initiative as soon as practicable, on a phased-in basis upon reissuance of the member’s card or annual renewal of eligibility or enrollment, whichever event comes first. The manner of identifying enrollment in the childless adult waiver must enable providers of MaineCare services to easily determine the member’s enrollment in the waiver.
B. The Department of Health and Human Services, Office of MaineCare Services shall initiate a procedure for the different preferred drug list for members of the childless adult waiver under subsection 1 that provides, at the time a disapproval is issued to a prescriber in response to a request for prior approval, a list of suitable and approvable generic and therapeutically equivalent drugs that could be approved.
C. By October 1, 2008 and January 1, 2009, the Department of Health and Human Services, Office of MaineCare Services shall provide an oral report to the MaineCare Advisory Committee, established pursuant to Department of Health and Human Services Rule Chapter 101, MaineCare Benefits Manual, Chapter 1, Section 1.23, regarding implementation of the different preferred drug list for members of the MaineCare childless adult waiver under subsection 1. The report must include the effects of implementation of the different preferred drug list on MaineCare members enrolled in the childless adult waiver, prescribers of drugs and the department.