Prior Authorization in Maine
Maine enacted LD 120 (2019) requiring step therapy override protections. The law includes broad exception criteria including when the prescriber determines the required step would be clinically inappropriate. Maine also requires PA decisions within 24 hours for urgent and 72 hours for standard drug requests.
Key Facts About PA in Maine
- ✓ Step therapy override with broad "clinically inappropriate" exception criterion
- ✓ Standard drug PA within 72 hours; urgent within 24 hours
- ✓ Maine Bureau of Insurance provides external review process
- ✓ Anthem BCBS Maine is the dominant commercial carrier
Quick Stats
- Typical Appeal Filing Window: 30 days
- External Review Available: Yes
- Major Payers: 4
Top Payers in Maine
RxCheckUp generates payer-specific Letters of Medical Necessity for each of these Maine carriers:
Anthem BCBS MaineAetnaUnitedHealthcareHarvard Pilgrim