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.

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: 

Diagnosis Code Requirement on Certain Pharmacy Claims

Diagnosis Code Requirement on Certain Pharmacy Claims

Effective January 25, 2024, the MO HealthNet Division (MHD) began requiring ICD10 diagnosis codes on pharmacy claims for select drugs and drug classes in order to gain further insight into actual real-world utilization of drug products for on and off-label indications. This will allow MHD to potentially improve the transparent processing of pharmacy claims for these select drugs and drug classes.

Asthma Inhaler Update

Asthma Inhaler Update

The MO HealthNet Pharmacy Program has become aware of a nationwide shortage of Asmanex® HFA inhalers. As brand name Flovent HFA® has also been discontinued by the manufacturer, this action has reduced access to maintenance medications for pediatric patients with asthma. In response to these changes in the marketplace, the following temporary changes in the Corticosteroids, Oral Inhaled PDL Edit will be effective 1/25/2024: 

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