MedicaidPrior AuthHigh impact
MO HealthNet Participants with Third Party Liability Coverage
Missouri Medicaid (MO HealthNet)·MO·Provider Notice
Effective date
Feb 4, 2025
We identified it
Jun 20, 2026
Summary
MO HealthNet (Missouri Medicaid) now requires providers to exhaust all third-party insurance benefits, including prior authorizations and appeals, before requesting prior authorization from Medicaid for medications. Medicaid will only review PA requests when third-party payers exclude all therapeutic alternatives from coverage.
Action Required
Immediately: Before submitting any prior authorization requests to MO HealthNet for medications, billing team must verify participant's third-party liability coverage and ensure all third-party benefits are utilized first. This includes pursuing prior authorization through the third-party payer, exploring therapeutic alternatives, and using preferred pharmacies. Only submit PA requests to MHD when third-party payers exclude ALL therapeutic alternatives, and include documentation of third-party PA denial plus appeal of coverage exclusion. Contact MHD Pharmacy Administration at MHD.PharmacyAdmin@dss.mo.gov or 573-751-6963 for case-by-case reviews.