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 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.
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.
Effective December 15, 2021, MO HealthNet will reinstate the requirement to document the offer to counsel and to maintain a signature log as proof of receipt of prescription delivery.
MO HealthNet covers up to a one-year supply of birth control in one prescription fill at the pharmacy. Pharmacies can convert a one-month prescription with refills to a three-month supply upon patient request without contacting the prescriber per RSMo 338.202. Please see this statute for requirements:https://revisor.mo.gov/main/OneSection.aspx?section=338.202
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.
Effective July 1, 2021 MO HealthNet will require a manual review of montelukast prescriptions for MO HealthNet participants by the pharmacy helpdesk when prescribed to participants with a history of suicidal thoughts, suicidal actions, and history of neuropsychiatric events. This change is due to the addition of the black box warning in the montelukast label (FDA Announcement).
On April 15, 2021 MO HealthNet introduced a new High Risk Therapies Clinical Edit for patients receiving concurrent opioids and benzodiazepines.
The final rule CMS-0055-F from the U.S. Department of Health and Human Services requires the reporting of the NCPDP Quantity Prescribed (460-ET) field for all Schedule II drugs on pharmacy claims as of September 21, 2020.
On November 21, 2019, the Pharmacy Help Desk (800-392-8030) began including additional menu options. You must listen to the entire opening message before selecting an option. This is to ensure the correct option is chosen. The new message and options are listed below. If no option is selected from the main menu, the main menu message will replay again.
Pharmacy message:
