MedicaidReimbursementMedium impact
COVID-19: Oral Antiviral Treatment
Missouri Medicaid (MO HealthNet)·MO·Provider Notice
Effective date
Jan 6, 2022
We identified it
Jun 20, 2026
Summary
MO HealthNet will reimburse pharmacy providers the professional dispensing fee for COVID-19 oral antivirals Paxlovid and molnupiravir, but product costs cannot be billed to MO HealthNet as the federal government covers the medication cost. Non-pharmacy providers like clinics and hospitals do not receive dispensing fees.
Action Required
Immediately: Pharmacy billing staff must ensure they only bill MO HealthNet for the professional dispensing fee when dispensing Paxlovid or molnupiravir prescriptions, not the product cost. Update billing system to prevent submission of drug product costs for these medications. Non-pharmacy providers (clinics, hospitals, ERs) should not attempt to bill dispensing fees for these medications.