MaineCare Responds to Pharmacy Vendor Network Disruption

Authorizes pharmacies to provide 30-day supplies of covered prescriptions to MaineCare members

AUGUSTA – MaineCare, Maine’s Medicaid program, is continuing to respond to a disruption caused by a cyber security issue affecting Change Healthcare, an out-of-state vendor that operates MaineCare’s pharmacy claims system. This is a national issue affecting health care systems and Medicaid members in many states.

Because Change Healthcare shut down its systems on February 21, 2024 to limit the impact of the cyber security issue, MaineCare has been temporarily unable to pay pharmacies for filling prescriptions for MaineCare members through the typical system. This has created questions and challenges for MaineCare members and pharmacies alike.

In response, the Department of Health and Human Services (DHHS) Office of MaineCare Services announced today that it has authorized pharmacies to provide prescriptions for up to 30 days to help MaineCare members access needed medications. This is an extension of the 3-day supply authorization that MaineCare provided to pharmacies last Friday. Pharmacies should continue to fill members' prescriptions as written by providers and process claims as they normally would. The Department will pay all eligible claims submitted once the system is operational again.

While DHHS works on temporary and permanent payment systems for pharmacies, pharmacies should neither turn away nor ask MaineCare members to pay out of pocket for any prescription that is covered by MaineCare. Such prescriptions may be needed for urgent illness as well as chronic conditions.

“It’s critically important that MaineCare members have and maintain access to their prescriptions,” said DHHS Commissioner Jeanne Lambrew. “We recognize the challenges MaineCare members are facing and will continue to do all we can to limit the impact of this disruption. We thank pharmacies for their help in ensuring access to needed medications under these extraordinary circumstances.”

DHHS is in close communication with Change Healthcare about its timeline for resolving these issues and returning to business as usual.

MaineCare members experiencing trouble getting their prescriptions filled may call the MaineCare Pharmacy Help Desk at 1–866–796–2463. They may experience delays due to call volume. Pharmacies may refer to the pharmacy provider guidance released earlier today for additional information.

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

The Department will share further updates as information becomes available.