Effective September 6, 2024, brand name Adderall XR^® will no longer be preferred on the MO HealthNet Preferred Drug List (PDL). Dextroamphetamine/Amphetamine ER capsules (generic Adderall XR^®) is currently a preferred agent on the PDL and will continue to remain a preferred agent. Please reference the List of Preferred & Non-Preferred Products, as well as the ADHD, Amphetamines Long Acting PDL edit for more information. Maximum Allowable Cost (MAC) rates will apply to brand and generic products. Providers who dispense the brand product without a prior authorization (based on medical necessity) will receive MAC reimbursement.

Also in Missouri, on August 29, the Medicaid Audit & Compliance (MMAC) launched the new secure Provider Communications Portal, which is an efficient method for providers and MMAC to communicate and exchange information and records.

Finally in Missouri, effective August 29, MO HealthNet expanded coverage of Continuous Glucose Monitors (CGMs) to participants currently diagnosed with Gestational Diabetes allowing this vulnerable population to obtain a CGM without prior authorization. Claims for a CGM will auto-approve if the participant has had a gestational diabetes diagnosis billed to MO HealthNet recently or if the pharmacy submits the appropriate gestational diabetes diagnosis code with the claim. Any MO HealthNet participant who currently utilizes insulin can also obtain a CGM without prior authorization.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

Effective August 1, 2024, MO HealthNet (Medicaid) no longer covers DisposeRx packets.

Also in Missouri, if a pharmacy does not have a drug take-back receptacle, the Board of Pharmacy provides one for free through its Rx Cares for Missouri Medication Destruction and Disposal Program.

Finally in Missouri, the Board of Pharmacy adopted rules expanding pharmacy technician duties published in the August 1, 2024 Missouri Register (20 CSR 2220-2.715).

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The MO HealthNet (MDH) Pharmacy Program (Medicaid) created several new resources:  

1. A 15-minute training course on Proper Drug Billing, covering National Drug Codes, how to determine and calculate what quantity to bill, who should bill for white and brown bagged medications and more.
2. Medicaid Eligibility Codes – Includes descriptions of Medicaid Eligibility (ME) Codes and limited and comprehensive benefits.
3. Contact Us – Provides provider contacts for MHD and more to assist with your questions
   These resources, as well as many others, can be found on our MHD Education & Training page. 
4. Provider Training Calendar – to register for a program specific training updated quarterly. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

Due to the increase in the Pharmacy Reimbursement Allowance (Pharmacy Tax), the adjustment to account for the Medicaid-reimbursed prescriptions was increased effective July 1, 2024. In-state pharmacy providers will continue to receive a professional dispensing fee of $12.22, plus an adjustment to account for the cost of the Pharmacy Reimbursement Allowance attributable to Medicaid-reimbursed prescriptions. The professional dispensing fee plus the current adjusted amount will total $12.42. Out-of-state pharmacy providers will continue to receive a professional dispensing fee of $8.85. Long-term care pharmacy providers supplying covered drugs to participants in long-term care facilities will continue to receive an additional $0.50 dispensing fee.

Also in Missouri, Gov. Mike Parson (R) allowed legislation NACDS supported, SB 751 relating to the distribution of 340B drugs, to become law without his signature, effective August 28, 2024.

Finally in Missouri, registration is open for the Board of Pharmacy’s “Lunch with the Chief Inspector” webinar on the 2024 legislative session and other Board of Pharmacy activities.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

NACDS sent a letter to Gov. Mike Parson (R) urging him to sign SB 751, legislation expanding the opportunity for pharmacies to participate in the 340B drug program. The bill also prohibits pharmaceutical manufacturers from restricting where patients can access their 340B medications, a restriction not in place before the pandemic. The Governor has until July 14 to act on the bill.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The Department of Social Services MO HealthNet (Medicaid) Pharmacy Preferred Drug List (PDL) and Utilization Management Edits updates are available online.  

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The Department of Health and Senior Services (DHSS) issued an updated naloxone standing order so that the prescription updates include the most evidence-based formulations and doses.

Also in Missouri, the Board of Pharmacy’s June 2024 newsletter is now available.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The Department of Social Services, MO HealthNet Division (MHD), reminded covered entities to comply with all the Health Resources and Services Administration (HRSA) 340B Program rules, including the exclusion of using 340B stock for inpatient administration and the prohibition of duplicate discounts.

Also in Missouri, to raise awareness about Project Hep Cure, Josh Moore, the Director of Pharmacy at MO HealthNet, sent a message to healthcare providers on how to help cure Missourians of the disease. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

MO HealthNet completed the annual review of the pharmacy preferred drug list and utilization management edits.

For more information, contact NACDS’ Mary Staples at 817-442-1155.