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MaineLD 1100132nd Maine Legislature (2025-2026)SenateWALLET

An Act to Clarify the Requirements for Accessing Nonformulary Drugs and Drugs Used to Treat Serious Mental Illness

Sponsored By: Donna Bailey (Democratic)

Became Law

PRESCRIPTION DRUGSPRESCRIPTION DRUGS - FORMULARIES

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Bill Overview

Analyzed Economic Effects

2 provisions identified: 2 benefits, 0 costs, 0 mixed.

Faster access to noncovered prescription drugs

Beginning July 1, 2025, you, your designee, or your prescriber can ask your insurer to cover a clinically appropriate drug your plan does not normally cover. The insurer must decide within 72 hours or 2 business days, whichever is less. For urgent cases that threaten life, health, recovery, or interrupt an ongoing nonformulary treatment, you get an answer within 24 hours. If approved, the drug counts as an essential health benefit. Your cost sharing counts toward your plan’s annual limit, and coverage lasts for the prescription, including refills. This applies to plan years starting on or after March 19, 2019.

Insurers must approve serious mental illness meds

Beginning July 1, 2025, your insurer must approve prior authorization for a formulary drug when it is prescribed to assess or treat a serious mental illness. Serious mental illness means a disorder in the most recent Diagnostic and Statistical Manual that seriously limits daily life. If that formulary drug is in shortage and no equivalent formulary drug exists, the insurer must approve and cover an equivalent nonformulary drug while the shortage lasts. This prevents gaps in needed mental health medicine.

Sponsors & Cosponsors

Sponsor

  • Donna Bailey

    Democratic • Senate

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

No roll call votes available for this bill.

Actions Timeline

  1. ACTPUB Chapter 473

    5/1/2026

  2. On motion by Senator ROTUNDO of Androscoggin taken from the Special Appropriations Table PASSED TO BE ENACTED in concurrence.

    6/25/2025Senate

  3. On motion by Senator ROTUNDO of Androscoggin PLACED ON THE SPECIAL APPROPRIATIONS TABLE pending ENACTMENT in concurrence.

    6/2/2025Senate

  4. PASSED TO BE ENACTED. Sent for concurrence. ORDERED SENT FORTHWITH.

    6/2/2025House

  5. CONSENT CALENDAR - FIRST DAYUnder suspension of the rules CONSENT CALENDAR - SECOND DAY.The Bill was PASSED TO BE ENGROSSED as Amended by Committee Amendment "A" (S-166).In concurrence. ORDERED SENT FORTHWITH.

    5/29/2025House

  6. Report READ and ACCEPTED.READ ONCE.Committee Amendment "A" (S-166) READ and ADOPTED.Under suspension of the Rules, READ A SECOND TIME and PASSED TO BE ENGROSSED AS AMENDED BY Committee Amendment "A" (S-166).Ordered sent down forthwith for concurrence.

    5/28/2025Senate

  7. CARRIED OVER, in the same posture, to the next special or regular session of the 132nd Legislature, pursuant to Joint Order SP 519.

    3/21/2025Senate

  8. Received by the Secretary of the Senate on March 14, 2025 and REFERRED to the Committee on HEALTH COVERAGE, INSURANCE AND FINANCIAL SERVICES pursuant to Joint Rule 308.2

    3/14/2025Senate

Bill Text

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