HIV/AIDS Pain Medication Process

February 5, 2013

The new MaineCare Pain Management Policy was implemented on January 1, 2013.

If you have a member under your care who has been diagnosed with HIV/AIDS, please note these key points: • Members diagnosed with HIV/AIDS are exempt from the policy.
• MIHMS does not allow pharmacies to identify members with HIV/AIDS who have full MaineCare benefits.

In order to avoid inappropriate denials for pain medication for members with HIV/AIDS, we suggest a work-around of completing a Prior Authorization (PA) with a diagnosis of HIV/AIDS or the code association with the diagnosis. The PA will be in effect for one (1) year, and prescriptions will need to be completed per policy. The PA will be automatically approved with an HIV/AIDS diagnosis.

Please share this information with the appropriate people in your office.

If you have questions, please contact Cee Dunn, RN at: Caroline.H.Dunn@maine.gov or 207-287-4758.