How is the Pharmacy Benefit Code, ME019, to be coded in view of some of the Prescription Coverage Mandates in the state of Maine?
If you cover an employer group in Maine and they opt out of any pharmacy coverage rider, but you still have to provide benefits for items like diabetic supplies or certain injectable products, then even though this data would come to us in the Pharmacy file transmission, you would load a “NO” value for the member(s) in this employer group.
