Pharmacy Benefits
MaineGeneral partners with Capital RX as our Pharmacy Benefit Manager (PBM) to process prescription claims. Capital RX will replace Optum as the PBM and will begin processing the claims filled through the MaineGeneral health plan, beginning January 1, 2026.
Pharmacy use:
Prescriptions at MaineGeneral are filled either through a pharmacy in the Capital RX’s network of pharmacies or the MaineGeneral Pharmacy based at the Thayer campus. Determining which medications can be filled at which type of pharmacy depends on the drug:
Capital RX Network Pharmacy: any medications that are not on the MaineGeneral Drug List can be filled a participating Capital Rx network pharmacy. This will be the largest percentage of most common medications. This network includes more than 60,000 pharmacies, including national chains and most independent pharmacies. Nearly any pharmacy you choose will be included in this network. If you would like to confirm that your preferred pharmacy is available in the network, you can view the National Chain Pharmacy Listing, or call Capital RX customer service: 1-833-202-6294.
MaineGeneral Pharmacy: To help you get the most value from your pharmacy benefits,
MaineGeneral Health has identified select medications that form the MaineGeneral Drug List that must be filled through MaineGeneral Pharmacy. This ensures you receive the most cost-effective coverage along with personalized pharmacy support. If a medication you’re taking is on this list, it must be filled at MaineGeneral Pharmacy at the Thayer campus, to be covered by the health plan. Medications that are not on this list cannot be filled at this pharmacy.
Drug Lists:
Other Helpful Pharmacy Resources:
