MedicaidAdministrativeMedium impact
Long-Term Care Maintenance Medication Billing
Missouri Medicaid (MO HealthNet)·MO·Pharmacy
Effective date
Feb 1, 2021
We identified it
Jun 20, 2026
Summary
Effective February 1, 2021, MO Health Net changed dispensing fee policy for long-term care maintenance medications to allow only one dispensing fee every 25 days (instead of each dispensing) for the same strength and dosage form. Additionally, all prior authorizations and overrides must be obtained before dispensing as MO Health Net will no longer backdate approvals for pharmacies who fail to obtain approvals beforehand.
Action Required
Long-term care pharmacies must update billing procedures to submit only one dispensing fee every 25 days for maintenance medications of the same strength and dosage form. All prior authorizations and overrides must be obtained before dispensing medications as backdated approvals will no longer be accepted. Update billing system to track 25-day dispensing fee cycles and ensure prior auth verification occurs before medication dispensing.