LD 1325
pg. 7
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LR 1609
Item 1

 
program must be immediately available and the cost of the
drugs must be reimbursed except as provided in this
paragraph.__The commissioner may impose prior
authorization requirements on drugs under the program.__
If the commissioner establishes maximum retail prices for
prescription drugs pursuant to section 2693, the
department shall adopt rules for the program requiring
the use of a drug formulary and prior authorization for
the dispensing of certain drugs to be listed on a
formulary.

 
(5)__The names of manufacturers who do and do not enter
into rebate agreements pursuant to this paragraph are
public information.__The department shall release this
information to health care providers and the public on
a regular basis and shall publicize participation by
manufacturers that is of particular benefit to the
public.

 
I.__The eligibility determination made by the department is
final, subject to appeal in accordance with the appeal
process established in the MaineCare program.

 
5.__Relationship to federal Medicare program.__To the extent
permitted by federal law and to the extent that funds are
available, the department may:

 
A.__Serve as the authorized representative for enrollees for
the purpose of enrollment in a Medicare Part D plan;

 
B.__Apply for Medicare Part D benefits and subsidies on
behalf of enrollees;

 
C.__Establish rules by which enrollees may opt out of the
procedures under paragraphs A and B;

 
D.__At its discretion, file exceptions and appeals
pertaining to Medicare Part D eligibility or benefits on
behalf of enrollees who are beneficiaries under Medicare
Part D.__The department may identify a designee for this
function;

 
E.__Identify objective criteria for evaluating Medicare Part
D plans for the purposes of assisting or enrolling persons
in those plans;

 
F.__Deem eligible for and enroll in the program without the
need for application individuals who are eligible for both
MaineCare and Medicare Part D;


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