Current through 2024-51, December 18, 2024
Subsection 144-104-3.02 - DEFINITIONS3.02-1Average Wholesale Price means the wholesale price charged on a specific commodity that is assigned by the drug manufacturer and is listed in a nationally recognized drug pricing file. 3.02-2Brand Name Drug is defined as a single-source drug, a cross-licensed drug, or an innovator drug.3.02-3Covered Drugs means drugs that are on the MaineCare Preferred Drug List established by the Department pursuant to its authority to operate the MaineCare program, and revised from time to time, as published on the Department's designated website.3.02-4Department means Department of Health and Human Services.3.02-5Generic Drugs are drugs other than those defined as brand-name drugs.3.02-6Initial Discounted Price for a drug means the amount that MaineCare reimburses pharmacies for any given drug pursuant to Section 80 of the MaineCare Benefits Manual.3.02-7Labeler means an entity or person who receives prescription drugs from a manufacturer or wholesaler and repackages those drugs for later retail sale and who has a labeler code from the Federal Food and Drug Administration under 21 CFR §207.20.3.02-8Mail Order Pharmacy is a pharmacy provider that dispenses prescription medications by U.S. mail or private carrier. Mail order pharmacies must have a NABP (National Association of Boards of Pharmacy) provider number uniquely identifying the provider as a mail order pharmacy for purposes of billing. Mail order pharmacies must be licensed by the Maine Board of Pharmacy, enrolled as Medicare and MaineCare providers, and be operating under contract with the Department. Mail order pharmacies must dispense prescription medications from within the United States. Mail order pharmacies must process claims through the State's electronic claims processing system to the standards required by the Department.3.02-9Metropolitan Statistical Area (MSA) is a federal standardized designation using postal zip codes to define rural areas. The Department will define rural by applying MSA/Non-MSA designation to the zip code of the member's residence.3.02-10National Drug Code (NDC) is the identifying number for a drug maintained by the Food and Drug Administration.3.02-11Participating Pharmacy means a pharmacy located in Maine, or another business licensed to dispense prescription drugs in this State, that participates in Maine Rx Plus, and that has signed a Maine Rx Plus provider agreement.3.02-12Retail pharmacy is a pharmacy that possesses a valid outpatient pharmacy license issued by the Board of Pharmacy, accepts Medicare assignment, and which serves Maine Rx Plus participants.3.02-13Secondary Discounted Price means the initial discounted price minus any further discounts paid for out of the Maine Rx Plus dedicated fund.3.02-14Telepharmacy is a method of delivering prescriptions dispensed by a pharmacist to a remote site. Pharmacies using telepharmacy delivery of prescriptions must follow all applicable State and Federal regulations and Maine State Board of Pharmacy rules, including using staff qualified to deliver prescriptions through telepharmacy. C.M.R. 10, 144, ch. 104, § 144-104-3, subsec. 144-104-3.02