Pharmacy Help Desk Menu Changes

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:

Pharmacy Services for MO HealthNet Participants with Presumptive Eligibility - Revised

MO HealthNet will reimburse any medication for a MO HealthNet participant dispensed within the eligibility period shown on a MO HealthNet Presumptive Eligibility Authorization (PE-3) form.

MO HealthNet will also reimburse any medication for a MO HealthNet participant dispensed within the eligibility period shown on a Show Me Healthy Babies Presumptive Eligibility (SMHB-PE) Authorization form.

Maximum Daily Units Edits

On August 19, 2018, the MO HealthNet Division (MHD) will implement a maximum daily quantity edit.  This quantity limit is based upon the maximum number of units of the drug allowed per day as determined by the MHD or First Databank’s (FDB) MedKnowledge.  The correct day's supply must be submitted on drug claims based on the quantity dispensed and the directions as written by the prescriber.  Claims submitted for a quantity above the maximum daily units will deny.

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.

Participant Responsibility to Pay the Shared Pharmacy Dispensing Fee

Providers must charge and collect the shared pharmacy dispensing fee amount required to be paid by MO HealthNet participants. Providers may not deny or reduce services solely on the basis of the participant's inability to pay the fee when charged. A participant's inability to pay a required amount shall in no way extinguish the participant's liability to pay the amount. The amount is a legal debt and is due to the provider.

Documentation for Offer to Counsel

Pharmacies are required to document the offer to counsel MO HealthNet participants on their prescription medications. The pharmacy must obtain the signature of the participant or his/her representative for each prescription received, with the exception of participants living in long-term care facilities, i.e. nursing facilities, intermediate care facilities/mentally retarded (ICF/MR) and/or psychiatric residential treatment facilities (PRTF).