Maine Revised Statutes > Title 24-A > Chapter 56-C – Health Plans That Provide Prescription Drug Benefits
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Terms Used In Maine Revised Statutes > Title 24-A > Chapter 56-C - Health Plans That Provide Prescription Drug Benefits
- Adult: means a person who has attained the age of 18 years. See Maine Revised Statutes Title 1 Sec. 72
- Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
- Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
- Average wholesale price: means the average wholesale price of a prescription drug as identified by a national drug pricing source selected by a health insurer. See Maine Revised Statutes Title 24-A Sec. 4347
- Basic necessities: means food, potable water, clothing, shelter, fuel, electricity, nonelective medical services as recommended by a physician, nonprescription drugs, telephone where it is necessary for medical reasons and any other commodity or service determined essential by the overseer in accordance with the municipality's ordinance and this chapter. See Maine Revised Statutes Title 22 Sec. 4301
- Commissioner: means the Commissioner of Health and Human Services. See Maine Revised Statutes Title 22 Sec. 1-A
- Compensation: means any direct or indirect financial benefit, including, but not limited to, rebates, discounts, credits, fees, grants, charge?backs or other payments or benefits of any kind. See Maine Revised Statutes Title 24-A Sec. 4347
- Covered person: includes the authorized representative of a covered person. See Maine Revised Statutes Title 24-A Sec. 4347
- Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
- Direct costs: means the total value of general assistance benefits paid out by a municipality that is in compliance with this chapter and the municipality's general assistance ordinance. See Maine Revised Statutes Title 22 Sec. 4301
- Dispensing fee: means the professional fee incurred at the point of sale or service that pays for pharmacy costs, in excess of ingredient cost, associated with ensuring that possession of the appropriate prescription drug is transferred to a covered person. See Maine Revised Statutes Title 24-A Sec. 4347
- Domestic partner: means one of 2 unmarried adults who are domiciled together under long-term arrangements that evidence a commitment to remain responsible indefinitely for each other's welfare. See Maine Revised Statutes Title 1 Sec. 72
- Dower: A widow
- Eligible person: means a person who is qualified to receive general assistance from a municipality according to standards of eligibility determined by the municipal officers whether or not that person has applied for general assistance. See Maine Revised Statutes Title 22 Sec. 4301
- Emergency: means any life threatening situation or a situation beyond the control of the individual which, if not alleviated immediately, could reasonably be expected to pose a threat to the health or safety of a person. See Maine Revised Statutes Title 22 Sec. 4301
- Fiduciary: A trustee, executor, or administrator.
- Formulary: means a list of prescription drugs covered by a health plan and any tier levels applicable to a prescription drug. See Maine Revised Statutes Title 24-A Sec. 4347
- General assistance program: means a service administered by a municipality for the immediate aid of persons who are unable to provide the basic necessities essential to maintain themselves or their families. See Maine Revised Statutes Title 22 Sec. 4301
- Generic drug: includes a biosimilar product. See Maine Revised Statutes Title 24-A Sec. 4347
- Homelessness: means a situation in which a person or household is:
A. See Maine Revised Statutes Title 22 Sec. 4301Household: means an individual or a group of individuals who share a dwelling unit. See Maine Revised Statutes Title 22 Sec. 4301 Impeachment: (1) The process of calling something into question, as in "impeaching the testimony of a witness." (2) The constitutional process whereby the House of Representatives may "impeach" (accuse of misconduct) high officers of the federal government for trial in the Senate. Income: means any form of income in cash or in kind received by the household, including net remuneration for services performed, cash received on either secured or unsecured credit, any payments received as an annuity, retirement or disability benefits, veterans' pensions, workers' compensation, unemployment benefits, benefits under any state or federal categorical assistance program, supplemental security income, social security and any other payments from governmental sources, unless specifically prohibited by any law or regulation, court ordered support payments, income from pension or trust funds, household income from any other source, including relatives or unrelated household members and any benefit received pursuant to Title 36, chapter 907, Title 36, section 5219?II and Title 36, section 5219?KK, unless used for basic necessities as defined in section 4301, subsection 1. See Maine Revised Statutes Title 22 Sec. 4301 Ingredient cost: means the actual amount paid to a pharmacy provider by a carrier or the carrier's pharmacy benefits manager for a prescription drug, not including the dispensing fee or cost?sharing amount. See Maine Revised Statutes Title 24-A Sec. 4347 Just cause: means a valid, verifiable reason that hinders an individual in complying with one or more conditions of eligibility. See Maine Revised Statutes Title 22 Sec. 4301 Landlord: means a person who owns a property and allows another person to use that property in return for payment. See Maine Revised Statutes Title 22 Sec. 4301 Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants. Lump sum payment: means a one-time or typically nonrecurring sum of money issued to an applicant or recipient. See Maine Revised Statutes Title 22 Sec. 4301 Mail order pharmacy: means a pharmacy whose primary business is to receive prescriptions by mail, by fax or through electronic submissions and to dispense medication to covered persons through the use of the United States mail or other common or contract carrier services and that provides any consultation with patients electronically rather than face to face. See Maine Revised Statutes Title 24-A Sec. 4347 Maximum allowable cost: means the maximum amount a health insurer will pay for a generic drug or brand?name drug that has at least one generic alternative available. See Maine Revised Statutes Title 24-A Sec. 4347 Municipal officers: means the mayor and municipal officers or councilors of a city, the members of the select board or councilors of a town and the assessors of a plantation. See Maine Revised Statutes Title 1 Sec. 72 Municipality of responsibility: means the municipality which is liable for the support of any eligible person at the time of application. See Maine Revised Statutes Title 22 Sec. 4301 Need: means the condition whereby a person's income, money, property, credit, assets or other resources available to provide basic necessities for the individual and the individual's family are less than the maximum levels of assistance established by the municipality. See Maine Revised Statutes Title 22 Sec. 4301 Net general assistance costs: means those direct costs incurred by a municipality in providing assistance to eligible persons according to standards established by the municipal officers and does not include the administrative expenses of the general assistance program. See Maine Revised Statutes Title 22 Sec. 4301 Network pharmacy: means a licensed retail pharmacy or other pharmacy provider that contracts with a pharmacy benefits manager. See Maine Revised Statutes Title 24-A Sec. 4347 Operator: means the lawful owner of a recovery residence or an individual or company designated by the lawful owner to have primary responsibility for the day-to-day operations of the recovery residence and for acquiring and maintaining certification pursuant to Title 5, section 20005, subsection 22 of the recovery residence in order to receive housing assistance payments through the general assistance program. See Maine Revised Statutes Title 22 Sec. 4301 Oral argument: An opportunity for lawyers to summarize their position before the court and also to answer the judges' questions. Overseer: means an official designated by a municipality to administer a general assistance program. See Maine Revised Statutes Title 22 Sec. 4301 Pharmacy: means an established location, either physical or electronic, that is licensed by the State and that has entered into a network pharmacy contract with a pharmacy benefits manager or carrier. See Maine Revised Statutes Title 24-A Sec. 4347 Pharmacy and therapeutics committee: means a committee, board or equivalent body established by a carrier to develop and maintain formularies. See Maine Revised Statutes Title 24-A Sec. 4347 Pharmacy benefits manager: means a person, business or other entity that, pursuant to a contract or under an employment relationship with a carrier, a self?insurance plan or other 3rd?party payer, either directly or through an intermediary, manages the prescription drug coverage provided by the carrier, self?insurance plan or other 3rd?party payer, including, but not limited to, processing and paying claims for prescription drugs, performing drug utilization review, processing drug prior authorization requests, adjudicating appeals or grievances related to prescription drug coverage, contracting with network pharmacies and controlling the cost of covered prescription drugs. See Maine Revised Statutes Title 24-A Sec. 4347 Pharmacy provider: means a retail pharmacy, mail order pharmacy or licensed pharmacist. See Maine Revised Statutes Title 24-A Sec. 4347 Probation: A sentencing alternative to imprisonment in which the court releases convicted defendants under supervision as long as certain conditions are observed. Real estate: includes lands and all tenements and hereditaments connected therewith, and all rights thereto and interests therein. See Maine Revised Statutes Title 1 Sec. 72 Retail pharmacy: means a chain pharmacy, a supermarket pharmacy, a mass merchandiser pharmacy, an independent pharmacy or a network of independent pharmacies that is licensed as a pharmacy by this State and that dispenses medications to the public. See Maine Revised Statutes Title 24-A Sec. 4347 Service of process: The service of writs or summonses to the appropriate party. Verdict: The decision of a petit jury or a judge.