Low Cost Drugs for the Elderly and Disabled
The Low Cost Drug Benefit (DEL) is funded by an appropriation from the State general fund. The program is not federally funded. To provide this program, the state works with pharmaceutical manufacturers that agree to participate in the rebate program. Coverage of drugs is limited to drugs on the DEL Preferred Drug List (PDL). This is the list of drugs for which the manufacturer has signed rebate agreements with the State.
Eligibility:
- Maine resident
- Age 62 and older, or age 19+ and disabled
- Income at or less than 185% FPL (income limit is 25% higher if at least 40% of yearly income is spent on prescription drugs)
Basic Benefit:
- The State pays 80% minus $2.00 of generic drugs on the DEL Preferred Drug List
- The State pays 80% minus $2.00 of the cost of brand-name medications on the DEL Preferred Drug List to treat the following diseases or conditions:
- ALS (Lou Gehrig's Disease)
- Anticoagulation
- Arthritis
- Chronic Lung Disease (including Emphysema and Asthma)
- Diabetes
- Glaucoma
- Heart Disease
- High Blood Pressure
- Hyperlipidemia (High Cholesterol)
- Incontinence
- Multiple Sclerosis
- Osteoporosis (Bone Density Loss)
- Parkinson's Disease
- Thyroid Disease
Supplemental Benefit:
The Supplemental benefit includes other drugs not covered in the Basic Benefit. The drugs must be medically necessary and supplied from participating manufacturers. Actual savings vary from drug to drug. DEL Members pay the State's negotiated MaineCare rate minus $2.00.
Catastrophic Spending Limit:
After a Member spends $1,000 on eligible prescription drugs, the State pays 80% of the cost of all eligible prescription drugs, regardless of any disease or condition. The drugs must be medically necessary and supplied from companies with agreements with the State. Eligible prescription drugs are only those drugs that were covered by DEL on May 31, 2001. The Catastrophic Spending Limit is tracked from August 1st each year to July 31st of the following year.
Note:
- Some drugs require 'prior approval' for coverage.
- Coverage through DEL is funding of last resort. Members with other prescription drug coverage must use those benefits first.
- Members with Medicare Part D coverage are eligible for DEL Wrap benefits only.
- The DEL PDL is posted at http://www.mainecarepdl.org/index.pl/pdlfiles
For more information:
If you are enrolled in DEL and have questions about coverage, call the DHHS Pharmacy Help Desk at
1-866-796-2463, TTY 1-800-325-0778.
To apply for the DEL program, contact your local DHHS office or your local Area Agency on Aging
