Missouri Rx Plan - General FAQs
No.
- What is MORx?
MORx is Missouri's State Pharmacy Assistance Program. MORx provides prescription drug assistance to Missourians in need by coordinating benefits with Medicare's (Part D) Prescription Drug Plan Program. Individuals receiving Medicare and MO HealthNet benefits are eligible for MORx coverage and automatically enrolled in the program. This includes participants receiving full MO HealthNet benefits, participants with a spend down requirement (regardless of meeting their spend down or not), and participants who receive only the coverage of their Medicare Part B premiums.
- What are the benefits of being enrolled in MORx?
MORx works with all approved Medicare Part D plans, including Medicare Advantage Drug Plans.
MORx pays for 50% of your out-of-pocket costs on medications that are covered by your Medicare Part D plan. If you have a Medicaid spend down requirement, the spend down must be met at least once during the calendar year for MORx benefits to work. When you meet the spend down requirement one time, MORx will start paying 50% toward your medication cost.
MORx members will continue to have coverage for Medicare-excluded drugs, provided they meet the MO HealthNet eligibility requirements. Medicare-excluded drugs covered by MORx include specific over-the-counter drugs, vitamins, minerals, and limited cough and cold drugs.
MORx covers up to a 31-day supply for each prescription. You can use any Missouri pharmacy that works with your Medicare Part D plan. If your doctor writes a prescription for a 90-day supply, submit it to your pharmacy and ask them to fill it in 30 or 31-day increments.
- Will I receive a MORx membership card?
No, MORx members will not receive a membership card. You will need to notify your pharmacy that you are a MORx member and provide them with a copy of your red, white, and blue Medicare card. Your MORx member ID will be the MBI number found on your Medicare card
- Does MORx have a cap or maximum payment amount for prescription drugs
No, MORx does not have a cap or maximum amount they will cover for your prescription drugs.
- Does MORx pay toward my Medicare Part D plan premium?
No, MORx will not pay your Medicare Part D plan premium
- Will MORx work with any Medicare Part D plan or Medicare Advantage Prescription Drug Plans
Yes, MORx will work with any approved Medicare Part D plan including Medicare Advantage Drug Plans
- What medications are not covered by MORx?
Compound drugs are not covered by MORx. Compound drugs are custom-made when your provider combines, mixes, or alters ingredients of a drug to create a medication tailored to meet your needs. They are usually prescribed when what you need is not available commercially.
MORx covers drugs that are covered by Medicare Part D plan first. If your Medicare Part D plan does not cover a drug, MORx will not cover it.
- Are brand name and generic drugs covered by MORx?
Yes, as long as the drug is covered by your Medicare Part D plan.
- Will the MORx benefit cover a 90-day supply of medication
No. The MORx benefit will not cover a 90-day supply of medication. If your doctor writes a prescription for a 90-day supply, turn it into your pharmacy and ask them to fill it in 30 or 31-day increments. The MORx benefit will cover up to a 31-day supply of each prescription at a time. You can get a full day's prescribed dosage for each day of the month with a maximum of 31 days each month.
- Will MORx work at my preferred local pharmacy?
Almost all Missouri pharmacies accept MORx. You must make sure the Medicare Part D plan you join has your preferred pharmacy in their network of pharmacies.
- Will MORx work with mail-order pharmacies?
No, MORx does not work with mail-order pharmacies. You can fill your prescriptions at any non-mail-order pharmacy that is contracted with your Medicare Part D plan and MORx will provide copay assistance. Many MORx participating pharmacies provide home delivery services at minimal or no additional charge.
- How will my pharmacy know that I am enrolled with MORx?
You will need to notify your pharmacy that you are a MORx member and provide them with a copy of your red, white, and blue Medicare card. Your MORx member ID will be the 11-digit Medicare Beneficiary Identifier (MBI) number found on your Medicare card
- How do I contact Medicare? What types of questions can Medicare answer for me?
You can call 1-800-Medicare (1-800-633-4227) or visit www.medicare.gov. Medicare can answer any questions you may have about your enrollment into a Part D plan, how to change plans or how to disenroll from a Part D plan. Medicare is also your best source for information if you are experiencing problems with your Part D plan.
- How do I choose a Medicare Part D plan? Who can tell me about the different prescription drug plans to find the one that is best for me?
The best sources for assistance are: or call 1-800-MEDICARE (1-800-633-4227) and CLAIM at 1-800-390-3330, which provides free health insurance counseling to Medicare participants in Missouri.
- What changed in my MO HealthNet coverage when I became eligible for MORx?
Only the pharmacy benefit changes. You will receive pharmacy benefits through your Medicare Part D plan and MORx
- If Medicare Part D does not cover a drug and the drug is not a Medicare Part D excluded drug, will MO HealthNet pay for the drug?
No.
- If a participant has Medicare Parts A and B, and is eligible for MO HealthNet under Blind Pension, do they need to enroll in a Part D plan? If they do not enroll if a Part D plan and later lose their blind pension, will they have to pay a late enrollment penalty
Yes. Individuals eligible for Blind Pension must enroll in a Part D plan.
- If Medicare Part D does not cover a drug and the drug is not a Medicare Part D excluded drug, will MO HealthNet pay for the drug?
No.
- If a participant has Medicare Parts A and B, and is eligible for MO HealthNet under Blind Pension, do they need to enroll in a Part D plan? If they do not enroll in a Part D plan and later lose their blind pension, will they have to pay a late enrollment penalty?
Yes. Individuals eligible for Blind Pension must enroll in a Part D plan.
- Are Medicare co-pays required for participants in Long Term Care?
After the first full month of residence in a skilled nursing facility, an intermediate care facility for the mentally retarded, or an inpatient psychiatric hospital, participants will have no co-pay.
- Do I have to pay the Medicare co-pays?
MORx will pay for half of the Medicare co-pay, but you must pay the rest. Medicare Part D co-pays are real co-pays. Your pharmacy may refuse your service if you do not pay your portion of the co-pay.
- If a participant does not enroll in a Medicare Part D plan, will MO HealthNet pay for Part D drugs?
No. Participants must enroll in a Part D plan for their prescription benefits
- Will MO HealthNet pay for any Medicare Part B drugs for participants?
Yes, MO HealthNet does pay the deductible and coinsurance amounts otherwise charged to the participant for Medicare Part B drugs.
- Who will cover Blood Glucose Test Strips?
Medicare Part B covers Blood Glucose Test Strips and the participant may continue to get these supplies through the Part B provider. MO HealthNet will pay the deductible and coinsurance amounts from Medicare Part B.
- How will OTC medications be covered for participants who have no spend-down?
MO HealthNet will continue to pay for drugs excluded from Medicare Part D coverage, including certain over-the-counter medications for dual eligibles. Claims for these drugs will need to meet current MO HealthNet edits
- Will I still have to pay my spend-down every month, since MO HealthNet will no longer be covering my prescriptions?
Yes, if medical services other than prescription drugs are required
- How does spend-down affect Medicare Part D drug costs?
If you have a Medicaid spend-down requirement, the spend-down must be met at least once during the calendar year for MORx benefits to work. When you meet the spend-down requirement one-time MORx will start paying 50% toward your medication cost
- If I am a participant enrolled in Medicare Part D, but I have not met my spend-down yet this month, will excludable drugs be covered by MO HealthNet?
No, but the cost of the excludable drugs will count toward spend-down.
- Do drugs not on the Medicare Part D formulary count toward spend-down?
Yes, if they are prescribed by a physician.
- Will Medicare Part D premiums count toward spend-down?
If the participant pays the premiums, this amount will count toward their spend-down.
- Since MO HealthNet is not covering my prescriptions any longer, will the amount of my spend-down be reduced?
No.
Revised October 2024