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* PLEASE NOTE: All cost effective generics applicable to ...

Jan 14, 2022 · F: Brand Name Medication Requests - (Must be submitted on the Brand Name PA request form)- According to MaineCare Benefits Manual Chapter II (80.07-5), when medically necessary covered brand-name drugs have an A-rated generic equivalent available, the most cost effective medically necessary version will be approved and reimbursed, since the ...

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