The Appeals Unit will help MaineCare and Drugs for the Elderly and Disabled (DELs) members who also have Medicare when their Part D Drug Plans deny coverage of their medication. The Unit will also help physicians and their staffs in filing coverage determination requests in obtaining any needed Part D information. There is no cost for this help.

Common reasons for denial of coverage that are subject to appeal include:

• The Plan takes the position that the prescribed drug is not medically necessary.
• The medication is a Part D drug, but is not on the Plan's formulary.
• The Plan requires Prior Authorization and it was denied or not obtained.
• The prescribed dosage is not covered by the Plan.
• The prescribed form (liquid/pill/injectable) or type (generic/brand name) of the drug is not covered by the Plan.
• The Plan is requiring step therapy.

Providers can also call the Part D Unit for information and for fax/phone numbers for the Part D Plans. Information is also available at the LSE website: www.mainelse.org

Calls taken Monday through Friday, 9 a.m. to Noon, and 1 p.m. to 4 p.m.