- 80% minus $2.00 of the cost of all generic prescription drugs on the Preferred Drug List.
- 80% minus $2.00 of the cost of brand-name medications on the Preferred Drug List for the treatment of diabetes, heart disase, high blood pressure, chronic lung disease (emphysema and asthma), arthritis, anticoagulation, Hyperlipidemia (high cholesteraol), incontinence, thyroid disease, osteoporosis, (bone density loss,), Parkinson’s Disease, glaucoma, Multiple Sclerosis, and ALS (Lou Gehrig’s Disease).
The Supplemental Benefit includes other drugs not covered in he basic Benefit. The drugs must be medically necessary and supplied from participating manufacturers. Actual savings vary from drug to drug. DEL Members pay the State’s negotiated MaineCare rate minus $2.00.
Catastrophic Spending Limit:
After a Member spends $1,000 on eligible prescription drugs, the State pays 80% of the cost of all eligible prescription drugs, regardless of any disease or condition. The drugs must be medically necessary and supplied from companies with agreements with the State. Eligible prescription drugs are only those drugs that were covered by DEL on May 31, 2001. The Catastrophic Spending Limit is tracked from August 1st each year to July 31st of the following year.
- Some drugs require ‘prior approval’ for coverage.
- Coverage through DEL is funding of last resort. Members with other prescription drug coverage must use those benefits first.
- Members with Medicare Part D coverage are eligible for DEL Wrap benefits only.
To request an application or for more information call: 1-866-796-2463, TTY: 1-800-606-0215.