Mandatory Generic Substitution for Prescription Drugs Update

November 9, 2012

In response to several requests, here is a reminder about the July 01, 2012 implementation of mandatory generic substitution requirements for prescription drugs, as required by law passed by the legislature. The MaineCare Benefits Manual, Section 80 reads:

The Department shall require substitution for a brand-name drug of a generic and therapeutically equivalent drug as required by Maine Revised Statues, Title 32, Section 13781, absent Prior Authorization from the Department. Prior Authorization requires that the prescriber has indicated that the brand-name drug must be dispensed and that the brand name drug is medically necessary.

MaineCare members may be able to still have brand name drugs covered if there is no therapeutically equivalent generic available or they have a Prior Authorization for a brand name prescription.

These changes are part of the Department of Health and Human Services’ Supplemental Budgets and Administrative Savings Initiatives that were signed by Governor LePage. See Public Law 2011, c. 477 and c. 657. You can find copies of the emergency, proposed and adopted rules at: http://www.maine.gov/dhhs/oms/rules/index.shtml. Select the link for emergency, proposed or adopted rules.