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Maine Medicaid Prior (Rx) Authorization Form

Maine MaineCare prior authorization form is a form used by a physician to request Medicaid coverage for a non-preferred drug that they prescribe to a Medicaid patient. On the form, the healthcare provider must provide a thorough medical justification for making the request and their reasons for not prescribing a preferred drug to their patient.
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Fax – 1 (888) 879-6938

Phone – 1 (888) 445-0497

Preferred Drug List – List of pre-approved drugs by the State