Attention Pharmacy Providers: Announcing Expanded Interim Payments for Certain Pharmacies and Continued Response to Change Healthcare Service Disruption

Mar 19, 2024

Announcing Expansion of Interim Payments to include Maine-based Health Systems Pharmacies:  

The Department of Health and Human Services (DHHS) is expanding interim pharmacy payments to include pharmacies that are part of Maine-based health systems, in response to the continued disruption of MaineCare’s pharmacy claims due to the national cyber security issue with Change Healthcare. The amount of the interim payment for these Maine health system-based pharmacies will equal 75% of the average weekly MaineCare reimbursement to each qualifying pharmacy before the disruption. The payments already in place for independent and safety net pharmacies will continue to equal 100% of the average weekly MaineCare reimbursement amount from before the disruption, as these pharmacies are more dependent on MaineCare pharmacy revenue to continue ongoing operations. See the lists of all eligible pharmacy organizations here. 

The Department will issue this additional interim payment this Wednesday, March 20, 2024. Health system-based pharmacies should receive payment on Thursday or Friday of this week depending on their bank and payment specifications. For providers that receive Remittance Advices, the interim payment will appear on the Remittance Advice, listed separately from any claims payments to the organization, and labeled as "Other." For providers receiving and utilizing electronic 835s, they can identify the payments under invoice numbers beginning with “PHRM.” Pharmacies do not need to apply for this interim payment but will be subject to reconciliation of payments once the disruption ends. Payment this week for this new round of health system-based pharmacies will be equal to 4 weeks of payment, to account for the disruption beginning on February 21, 2024, the first day of the system outage, to date.    

Once Change Healthcare resumes operations, the Department will provide retrospective reimbursement for all pharmacies serving MaineCare members back to February 21, 2024. The interim payments will be reconciled with actual claims payment amounts for verified MaineCare members during this process.  

To reach DHHS about this issue:  

• Pharmacies with questions about the interim payment may call MaineCare Provider Relations pharmacy representative Shannon Beggs at (207) 624-4012.  

Continued operations during this outage:  

MaineCare is actively working with Change Healthcare to make a restored version of Maine Point of Purchase System (MEPOPS) available for claims processing. We expect to restore MEPOPS to service within a few weeks and will send additional notifications when a restoration date is established. We appreciate the support and partnership with our enrolled pharmacy providers to ensure MaineCare members have access to medications. 

Announcing Renewal of Authorization for 30-day Supplies: 

MaineCare is renewing the authorization to issue up to a 30-day supply for prescriptions during this disruption. Please follow instructions shared in the initial 30-day supply authorization. 

MaineCare continues to require pharmacies to verify MaineCare coverage and has provided several ways to do so. 

Pharmacies checking individuals' MaineCare eligibility may call MaineCare Provider Services IVR at 1-866-690-5585. See the IVR Eligibility Check Instructions (PDF). Pharmacies can also check MaineCare member eligibility by logging into your secure trading partner account on the Health PAS Online Portal and clicking on the Eligibility Verification link. For full instructions to check eligibility, see the MHP Eligibility Verification User Guide.    

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.