MaineCare Launches Initial Restoration of Pharmacy Claims System

Pharmacies resume billing for MaineCare members' prescriptions, following vendor disruption

AUGUSTA– The Maine Department of Health and Human Services (DHHS) announced today that pharmacies have resumed billing MaineCare for members' prescriptions, following the disruption to its pharmacy claims system due to the national cyber security issue affecting Change Healthcare.

Effective yesterday, pharmacies may again bill MaineCare for member prescriptions during the disruption period, from February 21, 2024 through March 26, 2024, as well as for ongoing claims. MaineCare will pay all eligible claims submitted during the outage.

MaineCare launched this first phase of the system restoration in a new operating environment, following consultation with the Maine Office of Information Technology and a review of documentation provided by Optum, Change Healthcare’s parent company, and an external security firm to validate the security of the system. MaineCare additionally conducted extensive testing of payment and eligibility data.

The resumption of pharmacy claims processing and payment brings MaineCare closer to full restoration of the system. Some normal operating processes, including systems for prior authorizations, continue to be suspended while Change Healthcare works toward full restoration of its system.

“We continue to strive to limit the impact of this national disruption on MaineCare members and thank pharmacies and health providers for their partnership as we begin to return to normal operations,” said DHHS Commissioner Jeanne Lambrew. “We are in close communication with Change Healthcare during this transitional period and will do all we can to resolve any outstanding issues and ensure MaineCare members can continue to access needed medications.”

“Pharmacies have stepped up to serve Maine people by accomplishing a tremendous amount of additional work over the last five weeks. We’re pleased that operations are returning to normal and are encouraged by the collaboration between MaineCare and pharmacies in the face of this difficult situation,” said Amelia Arnold, Legislative Liaison, Maine Pharmacy Association. “MaineCare staff provided thoughtful and thorough information during the system downtime, allowing pharmacies to make appropriate plans. We look forward to continued collaboration as the system comes fully back online.”

The disruption resulted from a cybersecurity issue affecting Change Healthcare nationally, impacting health care systems and Medicaid members in many states. MaineCare has been working with members, pharmacies, and providers in response since Change Healthcare shut down its systems on February 21, 2024. MaineCare’s response includes authorizing pharmacies to provide prescriptions for up to 30 days to help MaineCare members access needed medications and issuing interim payments to help local pharmacies continue to serve MaineCare members. Maine-based pharmacies will receive another interim payment the first week of April in order to continue support until the claims payments are available. These interim payments will be reconciled with actual claims payment amounts for verified MaineCare. Pharmacies are expected to resume receiving claims payments by the end of the second week of April.

The system disruption has generated unexpected additional, one-time pharmacy costs for the Department. As Governor Mills prepares her budget change package, the Department is working on an initiative for her proposal to address the state share of these costs.

Throughout the disruption, MaineCare has urged pharmacies to continue filling prescriptions for MaineCare members. It has required pharmacies to continue to verify MaineCare coverage and provided numerous ways to do so.

Change Healthcare has not indicated that any personal data of MaineCare members was improperly accessed as part of the network disruption.

To reach DHHS about this issue:

  • Pharmacies may refer to the Department’s most recent provider bulletin
  • MaineCare members may call the MaineCare Pharmacy Help Desk at 1–866–796–2463