MedicaidPrior AuthHigh impact
Drug Prior Authorization Helpful Tips
Missouri Medicaid (MO HealthNet)·MO·Prior Authorization
Effective date
Nov 22, 2022
We identified it
Jun 20, 2026
Summary
MO HealthNet has updated drug prior authorization guidelines emphasizing complete form submission and requiring all PA requests to originate directly from prescriber offices or pharmacies, explicitly prohibiting third-party vendors like CoverMyMeds and ZAPPRX. Including diagnosis codes on e-prescriptions can reduce PA requests by 30%.
Action Required
Immediately: Stop using third-party PA vendors (CoverMyMeds, ZAPPRX) for MO HealthNet patients - all requests must come directly from prescriber office. Update e-prescribing workflow to include diagnosis codes, especially for antipsychotics, fibromyalgia drugs, opioids, and topical retinoids. Train staff to complete all PA forms entirely before submission and submit all documentation in single fax to 573-636-6470. Contact Conduent at 888-581-9797 to set up CyberAccess for electronic submissions.