Welcome to the MO HealthNet Pharmacy Program. The MO HealthNet Pharmacy Program oversees reimbursement for outpatient, fee-for-service prescription drugs, over-the-counter products and devices. The program is responsible for pharmacy program and policy development and uses best practices and evidence-based medicine to drive clinical policy development. Pharmacy Administration is responsible for the pharmacy program and policy development for MHD. Contact Pharmacy Administration at MHD.PharmacyAdmin@dss.mo.gov or call (573) 751-6963.
Education & Training
- Alcohol Use Disorder Treatment Options
- Albuterol Limit for Prescribers
- MO HealthNet Education & Training
- Opioid Policy Update
- Opioid Reversal Agents
- Pharmacy Billing Medical Claims
- Pharmacy Prior Authorization Process
- Pharmacy Provider Resource Guide
- Proper Drug Billing Course
Forms
- Provider Forms
- ADHD Medication Prior Authorization Children Less than 6 Years Old
- Antipsychotic Children less than 9 years old Prior Authorization
- Benzodiazepine Prior Authorization
- Compound Prior Authorization
- Continuous Glucose Monitoring Device Tubeless Insulin Pump Prior Authorization
- Diabetic Supplies Prior Authorization
- Drug Prior Authorization
- GLP-1 Receptor Agonists for All Indications Prior Authorization
- Growth Hormone Somatropin Agents Prior Authorization
- Hepatitis C Treatment Prior Authorization
- Opioid Prior Authorization
- Psychotropic Medication Polypharmacy Prior Authorization
- Request for Brand Name Drug Prior Authorization
- Synagis Prior Authorization
- Targeted Immune Modulators Prior Authorization Misc Allergy and Asthma-related Monoclonal Antibodies
Provider Manual
Resources
- Claims & Billing
- Drugs Carved Out of Inpatient Rate
- Drugs Carved Out of 340B Reimbursement
- Drugs with Coverage Limitations and New Drug Review
- FAQs
- Fee Schedules
- Missouri Maximum Allowable Cost For Specific Drug Products
- New Drug AMCP Guidelines (Abbr.) and Cover Letter - 9.1.19
- New Drug Review Process
- Provider Information
MO HealthNet News
The table below provides general information and updates that are relevant to this program page, as well as all MO HealthNet providers. To find information for all other MO HealthNet programs, or to search by date, program or keyword, visit the MO HealthNet News page. If you would like to receive updates in your inbox, subscribe to MO HealthNet News!
| Date | Volume Number | Subject | Type | Program |
|---|---|---|---|---|
| 12/17/2018 | NADAC Pricing Inquiries | Hot Tips | All MO HealthNet Providers | |
| 12/13/2018 | 41-29 | Medicare Crossover Claims | Bulletins | All MO HealthNet Providers |
| 12/11/2018 | 41-28 | Providers Billing Pharmacy Claims Reimbursement | Bulletins | Pharmacy |
| 10/17/2018 | 41-25 | ICD-10 Annual Updates 2018 | Bulletins | All MO HealthNet Providers |
| 10/12/2018 | 41-24 | Ordering Prescribing and Referring Provide Requirements | Bulletins | All MO HealthNet Providers |
| 10/10/2018 | 41-22 | Provider Enrollment Requirement | Bulletins | All MO HealthNet Providers |
| 10/05/2018 | 41-20 | Telehealth Telemedicine | Bulletins | All MO HealthNet Providers |
| 09/24/2018 | Updated EBPT Invoice | Hot Tips | All MO HealthNet Providers | |
| 09/21/2018 | 41-19 | Providers Billing Drug Claims Prescribing Provider NPI Requirement | Bulletins | Pharmacy |
| 08/23/2018 | 41-12 | Providers Billing Drug Claims Maximum Daily Units | Bulletins | Pharmacy |
| 08/17/2018 | Maximum Daily Units Edits | Hot Tips | Pharmacy | |
| 07/16/2018 | 41-06 | Primary Care Health Home | Bulletins | All MO HealthNet Providers |
| 05/11/2018 | Participants with Other Insurance Coverage | Hot Tips | All MO HealthNet Providers | |
| 02/26/2018 | Pharmacy Services for Participants with Presumptive Eligibility | Hot Tips | Pharmacy | |
| 02/21/2018 | 40-49 | Providers Billing Drug Claims Refill Too Soon | Bulletins | Pharmacy |