Mo. Code Regs. tit. 13 § 70-20.042
Current through Register Vol. 49, No. 23, December 2, 2024
Section 13 CSR 70-20.042 - Automatic Refill ProgramPURPOSE: The purpose of this amendment is to remove all Medication Synchronization Program language and add clarification on automatic refill.
PURPOSE: This rule establishes the regulatory basis to prohibit automatic refill of prescriptions by providers for MO HealthNet participants.
(1) Automatic Refill Program.(A) MO HealthNet does not allow automatic refills or automatic shipments of medications, devices, or supplies. MO HealthNet does not pay for any prescription without an explicit request from a participant or the participant's responsible party, such as a caregiver, for each refilling event. Participants and providers cannot waive the explicit refill request requirement and enroll in an automatic refill program.(B) This ban on automatic refills shall include all MO HealthNet participants, including dual eligible participants and participants with other primary insurance.(C) A nurse or other authorized agent of the facility may initiate a request for a refill for a participant residing in a skilled nursing facility, group home, or assisted living arrangement. 1. Cycle filling for a participant residing in a skilled nursing facility, group home, or assisted living arrangement does not constitute an automatic refill program as long as the pharmacy and facility staff have a policy and procedure in place to prevent medication that is discontinued or otherwise unneeded from being billed to MO HealthNet. Cycle-fill medication that does not follow the policy and procedure between the pharmacy and facility may be subject to administrative action.(D) Any prescription filled without a request from a participant or the participant's responsible party may be subject to recoupment. Any provider who pursues an automatic refill policy may be subject to administrative action.Adopted by Missouri Register December 15, 2022/Volume 47, Number 24, effective 1/29/2023Amended by Missouri Register June 1, 2023/Volume 48, Number 11, effective 7/31/2023Amended by Missouri Register April 1, 2024/volume 49, Number 07, effective 5/31/2024.