Herceptin Billing Policy Change
Effective for dates of service on or after April 1, 2023, MO HealthNet will require the product Herceptin by Genentech to be billed by the number of vials. Herceptin is available in a single-dose, powder-filled vial, and providers must bill by whole vials; no partial vials are allowed. Previously pricing for Herceptin was calculated per milligram and is now calculated per vial, necessitating this change. MO HealthNet has taken proactive steps to ensure claims no longer pay when billed by the milligram.
Opioids and CGMs may not need a PA
MO HealthNet does not require a prior authorization for opioid prescriptions less than 50 MME per day. Please note, for patients who have not filled an opioid through MO HealthNet in the past 90 days, the pharmacy will still need to run a 7-day fill prior to a full 30-day prescription, regardless of the MME.
Maternal infant Health Prenatal Vitamins
MO HealthNet wants to ensure that participants who are pregnant or hoping to conceive get the nutrition they need before and during pregnancy. Ideally, mothers-to-be would take prenatal vitamins before conception as brain development starts during the first month of pregnancy, often before mothers even know they are pregnant. During pregnancy, mothers also need more folic acid and iron than usual. A healthy diet is the best way to get the vitamins and minerals mothers need for a healthy pregnancy and the baby’s development.
What is MO HealthNet Presumptive Eligibility?...and how to make it work in my pharmacy
by ANGELA WILSON – Pharmacy Program Manager, MO HealthNet & ERICA MAHN, PharmD, BC-ADM – Executive Director of Community Pharmacy Services at Alps Pharmacy
Continuous Glucose Monitors Policy Update and Webinar on Proper CGM Use
We have some exciting news to share with you! The MO HealthNet Division (MHD) has recently updated its Continuous Glucose Monitors (CGMs) policy. We are pleased to inform you that participants on any insulin (short-acting or basal) can now receive a CGM by automated approval, with no manual paperwork or Prior Authorization process required. This new policy will greatly benefit participants and providers as it streamlines obtaining this important device.
Pharmacy Provider Alert List of Manufacturers Newly Excluded from Coverage (Effective 7-1-2023) Revised
CMS has rescinded the termination of Lupin (labeler codes 27437, 43386, 68180) from the Medicaid Drug Rebate Program. Claims from Lupin (labeler codes 27437, 43386, 68180) will continue to be payable.