MedicaidCoverageHigh impact
Temporary Deactivation of Maximum Daily Limits for Drugs on Crossover Claims
Missouri Medicaid (MO HealthNet)·MO · Pharmacy·Provider Bulletin
Effective date
Jul 23, 2026
We identified it
Jul 28, 2026
Summary
Missouri Medicaid has temporarily deactivated maximum daily limits for drugs on crossover claims (claims involving both Medicare and Medicaid). This means pharmacy claims that previously hit daily cap limits will now process without restriction during this temporary period. Billing teams must stop applying daily maximums to crossover drug claims and monitor for when this policy expires.
Action Required
Effective immediately (07/23/2026): Billing and pharmacy teams must update claim adjudication logic in all billing systems to remove or deactivate maximum daily limits specifically for crossover claims (dual Medicare/Medicaid beneficiaries). Flag claims in your system to ensure daily limits are NOT applied to drugs on crossover claims going forward. Train pharmacy billing staff to recognize crossover claims and not deny or reduce reimbursement based on daily maximums. Monitor the Missouri Department of Health and Senior Services (MHD) website for expiration date of this temporary policy and prepare for reactivation of daily limits when policy ends. Failure to remove daily limits may result in inappropriate claim denials and beneficiary access issues.