Listed below are all the PA forms you will need in order to request drugs that require prior authorization.
MaineCare Preferred Drug List
To submit a request:
- Select and print the proper form from the list below
- Fill out the form completely
- Fax the completed form to us at 1-888-879-6938
Log in to the MaineCare Rx Portal @ www.mainecarerxportal.org and submit PA's electronically
For answers to frequently asked questions and additional information on submitting a PA: PA Submission Instructions
(Please note - If the PA form asks for supporting medical documentation, please fax this information along with the completed PA form.)
If you cannot view a file, please download the appropriate free plug-in from the links below.