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 |
|---|---|---|---|---|
| 02/02/2018 | 40-47 | Telehealth | Bulletins | All MO HealthNet Providers |
| 01/30/2018 | 40-45 | 2018 Healthcare Common Procedure Coding System | Bulletins | All MO HealthNet Providers |
| 10/26/2017 | 40-27 | Ordering Prescribing and Referring Provider Requirements | Bulletins | All MO HealthNet Providers |
| 10/05/2017 | Reimbursement Issues – Pricing Inquiry Process | Hot Tips | All MO HealthNet Providers | |
| 10/05/2017 | Immunizations for Dual Eligible Participants | Hot Tips | All MO HealthNet Providers | |
| 10/05/2017 | Participant Responsibility to Pay the Shared Pharmacy Dispensing Fee | Hot Tips | Pharmacy | |
| 10/04/2017 | 40-25 | ICD-10 Annual Updates 2017 | Bulletins | All MO HealthNet Providers |
| 09/26/2017 | Outpatient Drug Quantity Billing | Hot Tips | Pharmacy | |
| 08/15/2017 | 40-18 | Providers Billing Pharmacy Claims | Bulletins | All MO HealthNet Providers |
| 08/10/2017 | 40-17 | Providers Billing Pharmacy Claims | Bulletins | All MO HealthNet Providers |
| 08/01/2017 | 40-16 | Medicaid Management Information System MMIS Data Center and Computer Hardware Replacement | Bulletins | All MO HealthNet Providers |
| 04/28/2017 | Aetna Inpatient Care | Hot Tips | All MO HealthNet Providers | |
| 04/28/2017 | Managed Care Goes Statewide on May 1, 2017 | Hot Tips | All MO HealthNet Providers | |
| 04/24/2017 | Verifying Participant Eligibility | Hot Tips | All MO HealthNet Providers | |
| 04/14/2017 | 39-52 | Providers Billing Pharmacy Claims | Bulletins | All MO HealthNet Providers |