Mo. Code Regs. tit. 13 § 70-20.045
Current through Register Vol. 49, No. 23, December 2, 2024
Section 13 CSR 70-20.045 - Thirty-One-Day Supply Maximum Restriction on Pharmacy Services Reimbursed by the MO HealthNet DivisionPURPOSE: The purpose of this amendment is to update "recipient" and "patient" to "participant," which is the current standard language. This amendment also adds an additional exemption to the thirty-one- (31-) day restriction to allow for a new ninety- (90-) day supply program identified in proposed rule 13 CSR 70-20.047 Ninety-Day Supply Requirement for Select Medications. The amendment also makes grammatical corrections by adding hyphens to the terms "thirty-one (31) days" or "ninety (90) days" when those terms are used as adjectives.
PURPOSE: This rule establishes a thirty-one- (31-) day supply maximum restriction per dispensing on pharmacy services reimbursed by the MO HealthNet Division on behalf of participants eligible for any of the fee-for-service programs.
(1) The maximum days' supply of medication that may be provided per dispensing on behalf of a participant eligible for any of the fee-for-service programs is thirty-one (31) days, except for those drugs and/or categories under the provisions of this rule. Medication may be dispensed in quantities less than a thirty-one- (31-) day supply, if so ordered by the prescriber, except as specified elsewhere in this rule.(2) Drugs and/or categories of medications that are exempt from the thirty-one- (31-) day supply limitation and therefore may be dispensed in quantities exceeding a thirty-one- (31-) day supply are made available in the MO HealthNet Pharmacy Manual, section 13.6.D(1). The MO HealthNet Pharmacy Manual is incorporated by reference in this rule as published by the Department of Social Services, MO HealthNet Division, 615 Howerton Court, Jefferson City, MO 65109, at its website http://manuals.momed.com/manuals/, October 2, 2020. This rule does not incorporate any subsequent amendments or additions. The division reserves the right to effectuate changes in the list of drugs and/or categories of medications that are exempt from the thirty-one- (31-) day supply limitation by amending this rule.(3) All spend down participants are exempt from the MO HealthNet thirty-one- (31-) day supply maximum restriction on pharmacy services.(4) Exemptions from the thirty-one- (31-) day supply limitation may be given with prior authorization by the MO HealthNet Division to prevent a higher level of care.(5) Drugs and/or categories of medications identified by 13 CSR 70-20.047 are exempt from the thirty-one- (31-) day supply limitation. AUTHORITY: sections 208.152, 208.153 and 208.201, RSMo 2000.* Emergency rule filed Nov. 21, 2000, effective Dec. 1, 2000, expired May 29, 2001. Original rule filed June 29, 2000, effective Feb. 28, 2001. Amended: Filed Dec. 5, 2000, effective June 30, 2001. Amended by Missouri Register October 15, 2018/Volume 43, Number 20, effective 11/30/2018Amended by Missouri Register June 1, 2021/Volume 46, Number 11, effective 7/31/2021*Original authority: 208.152, RSMo 1967, amended 1969, 1971, 1972, 1973, 1975, 1977, 1978, 1978, 1981, 1986, 1988, 1990, 1992, 1993; 208.153, RSMo 1967, amended 1973, 1989, 1990, 1991; and 208.201, RSMo 1987.