Updates to Coverage of Continuous Glucose Monitors (CGMs)
Updates to Coverage of Continuous Glucose Monitors (CGMs):
Effective August 29, 2024, MO HealthNet will expand coverage of Continuous Glucose Monitors (CGMs) to participants currently diagnosed with Gestational Diabetes allowing this vulnerable population to obtain a CGM without a prior authorization. Claims for a CGM will auto-approve if the participant has had a gestational diabetes diagnosis billed to MO HealthNet recently OR if the pharmacy submits the appropriate gestational diabetes diagnosis code with the claim.
Proper Drug Billing Resource
Proper Drug Billing Resource
The MO HealthNet Pharmacy Program is excited to introduce a new training course on Proper Drug Billing. This convenient training, which can be completed in less than 15 minutes, covers National Drug Codes, how to determine and calculate what quantity to bill, who should bill for white and brown bagged medications, and more. It will serve as a handy resource, as it includes helpful links and contact information.
Opioid Reversal Agents
Opioid Reversal Agents
In 2021, nearly 1 out of 47 deaths in Missouri were attributed to an opioid-involved overdose. Naloxone is an opioid antagonist indicated for the emergency treatment of known or suspected opioid overdose, as manifested by respiratory and/or central nervous system depression.
PACE Benefit Table
Program of All-Inclusive Care for the Elderly (PACE) Benefit Table
The Program of All-Inclusive Care for the Elderly (PACE) is administered by MO HealthNet and Medicare to provide comprehensive health care, social, recreational, and wellness services to its participants. One of the main goals of PACE is to allow older adults to live safely in their homes instead of nursing facilities. As of May 3, 2024, PACE organizations are active in St. Louis and Kansas City, with a new PACE organization coming to the Springfield area later this year.
Vaccines for CHIP Participants
Vaccines for CHIP Participants
Participants enrolled in the Children’s Health Insurance Program (CHIP) are not eligible for vaccines under the Vaccines for Children (VFC) Program. In order for providers to accurately report and document vaccines for CHIP participants, they must take the following steps.
GLP-1 Shortage
GLP-1 Shortage
Regarding: Anti-Diabetic Medication Shortages
MO HealthNet is aware of the continuing shortages of GLP-1 agonists in the marketplace. To avoid disruption in a participant’s diabetic therapy, please do not submit PA requests for non-preferred GLP-1 agonists if solely due to shortage or supply issues.
In the event you are unable to obtain the participant’s currently prescribed GLP-1 agonist through your wholesaler or another local pharmacy consider one of the following: