Vaccines for Children Program – Pharmacy Providers

MO HealthNet pharmacy providers not enrolled in the VFC program cannot administer vaccines to MO HealthNet participants covered under the VFC program. A VFC provider must immunize all MO HealthNet children for VFC vaccines. Through the VFC Program, federally provided vaccines are available at no cost to public and private providers for eligible children ages 0 through 18 years of age. Children that meet at least one of the following criteria are eligible for VFC vaccine:

Drug Prior Authorization Helpful Tips

MO HealthNet often receives only partial information on PA requests for medication. This partial information leads to an increase in call and fax volume at the helpdesk and causes increased calls and faxes to your offices to obtain the necessary information, and slows down the PA process.

Please help us respond quickly to your requests by reviewing the information below.

Enrolling Pharmacists

Enrolling Pharmacists as Individual MO HealthNet Providers

Many pharmacists are currently interested in enrolling as individual MO HealthNet providers to bill MO HealthNet for prescriptions ordered by pharmacists, such as at-home COVID tests. Pharmacists interested in only ordering, prescribing, or referring services for MO HealthNet participants should enroll as Ordering, Prescribing, Referring providers. Pharmacists interested in performing or billing for services rendered to MO HealthNet participants should enroll as billing or performing provider.

Pharmacy Services for Participants with Presumptive Eligibility

The MO HealthNet Presumptive Eligibility Authorization (PE-3) form and the Show Me Healthy Babies Presumptive Eligibility (SMHB-PE) Authorization form serve as proof of presumptive eligibility. Pharmacy providers should check the dates of eligibility on the authorization form to determine if the presumptive eligibility period is active. Pharmacy providers should make a photocopy of the form and maintain the copy in the pharmacy files for documentation of eligibility.

Long-Term Care Maintenance Medication Billing

Effective February 1, 2021, the dispensing fee policy for maintenance medications changed from paying each time the maintenance medication is dispensed to allowing only one dispensing fee every 25 days for a participant receiving the same strength and dosage form of the maintenance medication. This change allows long-term care pharmacies to submit claims in real-time according to their cycle fill schedule.

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