ÐÏࡱá > þÿ ñ ó þÿÿÿ ï ð ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿì¥Á g ð¿  Š bjbjXÿXÿ * :•j:•jô" ÿÿ ÿÿ ÿÿ · ¥ ¥ ¥ ¥ ¥ ÿÿÿÿ ¹ ¹ ¹ ¹ ¬ e Ì ¹ G% 2 1 1 1 1 1 *$ ,$ ,$ ,$ ,$ ,$ ,$ $ y( ¶ /+ œ P$ ± ¥ P$ ¥ ¥ 1 1 Û % ê" ê" ê" þ ¥ 1 ¥ 1 *$ ê" *$ ê" ê" ê" 1 ÿÿÿÿ ð¤¡Z]Ü ÿÿÿÿ ! ¦ ê" $ % 0 G% ê" Ë+ °! Ë+ ê" ê" Ë+ ¥ þ" ê" P$ P$ À! * G% ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ Ë+ Y k : Title 13—department of social services Division 70—MO HealthNet Division Chapter 20—Pharmacy Program 13 CSR 70-20.010 Participating Drug Vendors (Rescinded September 30, 2018) AUTHORITY: section 207.020, RSMo 1986. This rule was previously filed as 13 CSR 40-81.011. Original rule filed Nov. 13, 1978, effective Feb. 11, 1979. Rescinded: Filed March 2, 2018, effective Sept. 30, 2018. 13 CSR 70-20.030 Drugs Covered by the MO HealthNet Division PURPOSE: This rule implements recent changes in drug coverage as mandated by the Centers for Medicare & Medicaid Services (CMS). (1) Drugs covered under the MO HealthNet Division must meet the definition of a prescribed drug as defined in 42 CFR 440.120(a), as amended, or a covered outpatient drug as defined in the Social Security Act, section 1927(k)(2) and section 1927(k)(4), as amended. AUTHORITY: sections 208.201 and 660.017, RSMo 2016, and sections 208.152 and 208.153, RSMo Supp. 2024.* This rule was previously filed as 13 CSR 40-81.010. Original rule filed Jan. 21, 1964, effective Jan. 31, 1964. Amended: Filed March 30, 1964, effective April 10, 1964. Amended: Filed April 27, 1965, effective May 7, 1965. Amended: Filed Dec. 7, 1966, effective Dec. 17, 1966. Amended: Filed Oct. 11, 1967, effective Oct. 21, 1967. Amended: Filed Oct. 19, 1967, effective Oct. 29, 1967. Amended: Filed Jan. 22, 1968, effective Feb. 2, 1968. Amended: Filed Aug. 24, 1968, effective Sept. 4, 1968. Amended: Filed April 16, 1970, effective April 26, 1970. Amended: Filed Feb. 16, 1971, effective Feb. 26, 1971. Amended: Filed Jan. 3, 1973, effective Jan. 13, 1973. Amended: Filed Feb. 6, 1975, effective Feb. 16, 1975. Amended: Filed March 9, 1977, effective June 11, 1977. Amended: Filed June 13, 1977, effective Oct. 1, 1977. Amended: Filed March 13, 1978, effective June 11, 1978. Amended: Filed Feb. 1, 1979, effective May 11, 1979. Emergency amendment filed July 26, 1979, effective Aug. 1, 1979, expired Oct. 10, 1979. Amended: Filed July 16, 1979, effective Oct. 11, 1979. Emergency amendment filed Aug. 11, 1981, effective Aug. 21, 1981, expired Nov. 11, 1981. Amended: Filed Aug. 11, 1981, effective Nov. 12, 1981. Emergency amendment filed Dec. 21, 1981, effective Jan. 1, 1982, expired April 10, 1982. Emergency amendment filed Jan. 21, 1982, effective Feb. 1, 1982, expired April 10, 1982. Amended: Filed Dec. 21, 1981, effective April 11, 1982. Emergency amendment filed July 22, 1982, effective Aug. 1, 1982, expired Nov. 10, 1982. Amended: Filed July 22, 1982, effective Nov. 11, 1982. Emergency amendment filed Sept. 30, 1982, effective Oct. 10, 1982, expired Jan. 28, 1983. Amended: Filed Jan. 14, 1983, effective May 12, 1983. Amended: Filed July 13, 1983, effective Oct. 13, 1983. Emergency amendment filed Dec. 21, 1983, effective Jan. 1, 1984, expired March 30, 1984. Emergency amendment filed March 21, 1984, effective March 31, 1984, expired July 11, 1984. Amended: Filed March 21, 1984, effective July 12, 1984. Emergency amendment filed April 20, 1984, effective May 1, 1984, expired July 11, 1984. Amended: Filed June 13, 1984, effective Sept. 14, 1984. Amended: Filed Sept. 12, 1984, effective Jan. 12, 1985. Amended: Filed Jan. 15, 1985, effective April 11, 1985. Amended: Filed April 16, 1985, effective July 11, 1985. Amended: Filed Oct. 2, 1985, effective Jan. 1, 1986. Amended: Filed April 16, 1986, effective July 1, 1986. Amended: Filed Sept. 17, 1986, effective Dec. 1, 1986. Amended: Filed Nov. 14, 1986, effective Feb. 12, 1987. Emergency amendment filed Dec. 18, 1986, effective Jan. 1, 1987, expired Feb. 11, 1987. Amended: Filed Feb. 18, 1987, effective May 1, 1987. Amended: Filed April 17, 1987, effective July 1, 1987. Amended: Filed June 16, 1987, effective Sept. 1, 1987. Amended: Filed Aug. 18, 1987, effective Nov. 12, 1987. Amended: Filed Dec. 1, 1987, effective Feb. 11, 1988. Amended: Filed April 4, 1988, effective July 1, 1988. Amended: Filed July 15, 1988, effective Oct. 13, 1988. Amended: Filed Sept. 15, 1988, effective Dec. 11, 1988. Amended: Filed April 4, 1989, effective July 1, 1989. Amended: Filed June 6, 1989, effective Sept. 1, 1989. Amended: Filed June 30, 1989, effective Oct. 1, 1989. Amended: Filed Nov. 15, 1989, effective Feb. 1, 1990. Amended: Filed Feb. 16, 1990, effective May 1, 1990. Amended: April 18, 1990, effective June 30, 1990. Amended: Filed Aug. 10, 1990, effective Dec. 31, 1990. Emergency amendment filed Dec. 21, 1990, effective Jan. 1, 1991, expired April 30, 1991. Emergency rescission and rule filed March 21, 1991, effective March 31, 1991, expired July 28, 1991. Emergency rescission filed April 2, 1991, effective April 12, 1991, expired Aug. 9, 1991. Emergency rule filed April 2, 1991, effective April 13, 1991, expired Aug. 10, 1991. Emergency amendment filed June 21, 1991, effective July 1, 1991, expired Aug. 10, 1991. Emergency rescission filed July 31, 1991, effective Aug. 11, 1991, expired Dec. 6, 1991. Rescinded: Filed March 21, 1991, effective Sept. 30, 1991. Emergency rule filed July 31, 1991, effective Aug. 11, 1991, expired Dec. 7, 1991. Readopted: Filed July 15, 1991, effective Jan. 13, 1992. Emergency amendment filed Sept. 23, 1991, effective Oct. 3, 1991, expired Dec. 7, 1991. Emergency rule filed Nov. 27, 1991, effective Dec. 8, 1991, expired April 5, 1992. Emergency amendment filed March 24, 1992, effective April 1, 1992, expired July 29, 1992. Emergency amendment filed June 16, 1992, effective July 1, 1992, expired Oct. 28, 1992. Amended: Filed March 24, 1992, effective Sept. 6, 1992. Emergency amendment filed Sept. 21, 1992, effective Oct. 1, 1992, expired Jan. 28, 1993. Emergency amendment filed Jan. 15, 1993, effective Jan. 29, 1993, expired May 28, 1993. Amended: Filed June 16, 1992, effective April 8, 1993. Emergency amendment filed March 19, 1993, effective April 1, 1993, expired July 29, 1993. Emergency amendment filed June 18, 1993, effective July 1, 1993, expired Oct. 28, 1993. Amended: Filed April 6, 1993, effective Dec. 9, 1993. Rescinded and readopted: Filed Oct. 15, 1993, effective June 6, 1994. Amended: Filed June 29, 2000, effective Dec. 30, 2000. Amended: Filed Aug. 28, 2018, effective April 30, 2019. Amended: Filed Aug. 16, 2024, effective April 30, 2025. *Original authority: 208.152, RSMo 1967, amended 1969, 1971, 1972, 1973, 1975, 1977, 1978, 1978, 1981, 1986, 1988, 1990, 1992, 1993, 2004, 2005, 2007, 2011, 2013, 2014, 2015, 2016, 2018, 2021, 2023, 2024; 208.153, RSMo 1967, amended 1967, 1973, 1989, 1990, 1991, 2007, 2012, 2024; 208.201, RSMo 1987, amended 2007; and 660.017, RSMo 1993, amended 1995. 13 CSR 70-20.031 List of Drugs for Which Prior Authorization Is Required and Drugs Excluded from Coverage Under the MO HealthNet Pharmacy Program PURPOSE: This rule establishes a listing of drugs and categories of drugs for which prior authorization is required in order for them to be reimbursable and for which reimbursement is not available under the MO HealthNet Pharmacy Program. PUBLISHER’S NOTE:  The secretary of state has determined that the publication of the entire text of the material which is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive.  This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here. (1) E x c l u s i o n s A s u s e d i n s e c t i o n 2 0 8 . 1 5 2 . 1 ( 1 2 ) , R S M o , a n y a b o r t i f a c i e n t d r u g o r d e v i c e i n c l u d e s : m i f e p r i s t o n e w h e n u s e d t o i n d u c e a n a b o r t i o n ; m i s o p r o s t o l w h e n u s e d t o i n d u c e a n a b o r t i o n ; m a n u a l v a c u u m a s p i r a t o r ( M V A ) w h e n u s e d t o i n d u c e a n a b o r t i o n ; o r a n y drug or device approved by the federal Food and Drug Administration (FDA) that the FDA has found on or after the effective date of section 208.152.1(12), RSMo, that is intended to cause the destruction of an unborn child as defined in section 188.015, RSMo. (2) Exclusions—As specified in the Social Security Act, Section 1927(d)(1)(B), states may exclude or otherwise restrict coverage of certain covered outpatient drugs. Section 1927(d)(2) of the Social Security Act provides a listing of the categories of drugs that states may exclude. Drugs included on this list may be excluded from coverage entirely or restricted by diagnosis as determined by the state. (3) As specified in Section 1927(d)(1) of the Social Security Act, states may subject to prior authorization any covered outpatient drug. Any such prior authorization program shall comply with the requirements of Section 1927(d)(5) of the Social Security Act. (4) List of drugs or categories of drugs for which prior authorization is required for certain spe c i f i e d i n d i c a t i o n s , a n d t h o s e w h i c h a r e e x c l u d e d f r o m r e i m b u r s e m e n t t h r o u g h t h e M O H e a l t h N e t P h a r m a c y P r o g r a m s h a l l b e m a d e a v a i l a b l e t h r o u g h ( A ) M O H e a l t h N e t p r o v i d e r m a n u a l s , w h i c h a r e i n c o r p o r a t e d b y r e f e r e n c e a n d m a d e a p a r t o f t h i s r u l e a s p u b l i s h e d by the Department of Social Services, MO HealthNet Division, 615 Howerton Court, Jefferson City, MO 65109, at its website at http://manuals.momed.com/manuals/, September 27, 2018. This rule does not incorporate any subsequent amendments or additions; (B) Provider Bulletins, which are incorporated by reference and made a part of this rule as published by the Department of Social Services, MO HealthNet Division, 615 Howerton Court, Jefferson City, MO 65109, at its website at https://dss.mo.gov/mhd/providers/pages/bulletins.htm, September 27, 2018. This rule does not incorporate any subsequent amendments or additions; or (C) Forms, which are incorporated by reference and made a part of this rule as published by the Department of Social Services, MO HealthNet Division, 615 Howerton Court, Jefferson City, MO 65109, at its website at http://manuals.momed.com/manuals/presentation/forms.jsp, September 27, 2018. This rule does not incorporate any subsequent amendments or additions. (5) The division reserves the right to effect changes in the list of drugs for which prior authorization is required and for which reimbursement is not available by amending this rule. AUTHORITY: sections 1.205, 208.153, 208.201, and 660.017, RSMo 2016, and section 208.152, RSMo Supp. 2021.* Original rule filed Dec. 13, 1991, effective Aug. 6, 1992. Amended: Filed May 15, 1992, effective Jan. 15, 1993. Amended: ýÿF i l e d M a r c h 1 , 1 9 9 6 , e f f e c t i v e O c t . 3 0 , 1 9 9 6 . A m e n d e d : F i l e d M a y 2 7 , 1 9 9 9 , e f f e c t i v e D e c . 3 0 , 1 9 9 9 . E m e r g e n c y a m e n d m e n t f i l e d N o v . 2 1 , 2 0 0 0 , e f f e c t i v e D e c . 1 , 2 0 0 0 , e x p i r e d M a y 2 9 , 2 0 0 1 . A m e n d e d : F i l e d J u n e 2 9 , 2 0 0 0 , e f f e c t i v e F e b . 2 8 , 2 0 0 1 . E m e r g e n c y a m e ndment filed June 7, 2002, effective July 1, 2002, expired Dec. 27, 2002. Amended: Filed June 11, 2002, effective Jan. 30, 2003. Amended: Filed Jan. 16, 2007, effective July 30, 2007. Amended: Filed Sept. 16, 2013, effective March 30, 2014. Amended: Filed Sept. 27, 2018, effective May 30, 2019. Emergency amendment filed Oct. 21, 2021, effective Nov. 4, 2021, expired May 2, 2022. Amended: Filed Oct. 21, 2021, effective April 30, 2022. *Original authority: 1.205, RSMo 1986; 208.152, RSMo 1967, amended 1969, 1971, 1972, 1973, 1975, 1977, 1978, 1978, 1981, 1986, 1988, 1990, 1992, 1993, 2004, 2005, 2007, 2011, 2013, 2014, 2015, 2016, 2018, 2021; 208.153, RSMo 1967, amended 1967, 1973, 1989, 1990, 1991, 2007, 2012; 208.201, RSMo 1987, amended 2007; and 660.017, RSMo 1993, amended 1995. 13 CSR 70-20.032 List of Excludable Drugs Excluded From Coverage Under the MO HealthNet Pharmacy Program (Rescinded January 30, 2019) AUTHORITY: sections 208.153 and 208.201, RSMo Supp. 2013. Original rule filed Dec. 13, 1991, effective Aug. 6, 1992. Amended: Filed June 30, 2000, effective Feb. 28, 2001. Emergency amendment filed June 7, 2002, effective July 1, 2002, expired Dec. 27, 2002. Amended: Filed June 11, 2002, effective Jan. 30, 2003. Amended: Filed Jan. 16, 2007, effective July 30, 2007. Amended: Filed Sept. 16, 2013, effective March 30, 2014. Rescinded: Filed June 8, 2018, effective Jan. 30, 2019. 13 CSR 70-20.033 Medicaid Program Coverage of Investigational Drugs Used in the Treatment of Acquired Immunodefi-ciency Syndrome (AIDS) (Rescinded September 30, 2018) AUTHORITY: sections 208.152, 208.153 and 208.201, RSMo 1994. Emergency rule filed Dec. 15, 1995, effective Jan. 1, 1996, expired June 28, 1996. Original rule filed Dec. 15, 1995, effective July 30, 1996. Rescinded: Filed March 2, 2018, effective Sept. 30, 2018. 13 CSR 70-20.034 List of Non-Excludable Drugs for Which Prior Authorization Is Required (Rescinded May 30, 2019) AUTHORITY: sections 208.152, 208.153, and 208.201, RSMo Supp. 2008. Emergency rule filed Nov. 21, 2000, effective Dec. 1, 2000, expired May 29, 2001. Original rule filed June 29, 2000, effective Feb. 28, 2001. Emergency amendment filed June 7, 2002, effective July 1, 2002, expired Dec. 27, 2002. Amended: Filed June 11, 2002, effective Jan. 30, 2003. Amended: Filed Jan. 16, 2007, effective July 30, 2007. Amended: Filed Aug. 17, 2009, effective Feb. 28, 2010. Rescinded: Filed Sept. 27, 2018, effective May 30, 2019. 13 CSR 70-20.040 Five Prescription Limit Per Month Per Recipient (Rescinded January 30, 2019) AUTHORITY: sections 208.153, RSMo Supp. 1991 and 208.201, RSMo Supp. 1987. This rule was previously filed as 13 CSR 40-81.012. Emergency rule filed Oct. 21, 1981, effective Nov. 1, 1981, expired Feb. 10, 1982. Original rule filed Oct. 21, 1981, effective Feb. 11, 1982. Amended: Filed March 14, 1984, effective June 11, 1984. Amended: Filed June 12, 1984, effective Sept. 14, 1984. Amended: Filed Jan. 15, 1985, effective April 11, 1985. Amended: Filed April 16, 1985, effective July 11, 1985. Amended: Filed Oct. 2, 1985, effective Jan. 1, 1986. Amended: Filed April 16, 1986, effective July 1, 1986. Emergency amendment filed Dec. 18, 1986, effective Jan. 1, 1987, expired Feb. 11, 1987. Amended: Filed Sept. 17, 1986, effective Dec. 1, 1986. Amended: Filed Nov. 14, 1986, effective Feb. 12, 1987. Amended: Filed Feb. 18, 1987, effective May 1, 1987. Emergency amendment filed Dec. 18, 1986, effective Jan. 1, 1987, expired Feb. 11, 1987. Amended: Filed April 17, 1987, effective July 1, 1987. Amended: Filed June 16, 1987, effective Sept. 1, 1987. Amended: Filed Aug. 18, 1987, effective Nov. 12, 1987. Amended: Filed Dec. 1, 1987, effective Feb. 11, 1988. Amended: Filed April 15, 1988, effective July 1, 1988. Amended: Filed July 15, 1988, effective Oct. 13, 1988. Amended: Filed July 15, 1988, effective Oct. 13, 1988. Amended: Filed Sept. 15, 1988, effective Dec. 11, 1988. Amended: Filed April 4, 1989, effective July 1, 1989. Amended: Filed June 6, 1989, effective Sept. 1, 1989. Amended: Filed June 30, 1989, effective Oct. 1, 1989. Amended: Filed Nov. 15, 1989, effective Feb. 1, 1990. Amended: Filed Aug. 13, 1990, effective Dec. 31, 1990. Emergency amendment filed Dec. 21, 1990, effective Jan. 1, 1991, expired April 30, 1991. Emergency amendment filed March 21, 1991, effective April 1, 1991, expired July 29, 1991. Amended: Filed March 13, 1991, effective Oct. 31, 1991. Rescinded: Filed June 8, 2018, effective Jan. 30, 2019. 13 CSR 70-20.042 Automatic Refill Program PURPOSE: This rule establishes the regulatory basis to prohibit automatic refill of prescriptions by providers for MO HealthNet participants. (1) Automatic Refill Program. (A) MO HealthNet does not allow automatic refills or automatic shipments of medications, devices, or supplies. MO HealthNet does not pay for any prescription without an explicit request from a participant or the participant’s responsible party, such as a caregiver, for each refilling event. Participants and providers cannot waive the explicit refill request requirement and enroll in an automatic refill program. (B) This ban on automatic refills shall include all MO HealthNet participants, including dual eligible participants and participants with other primary insurance. (C) A nurse or other authorized agent of the facility may initiate a request for a refill for a participant residing in a skilled nursing facility, group home, or assisted living arrangement. 1. Cycle filling for a participant residing in a skilled nursing facility, group home, or assisted living arrangement does not constitute an automatic refill program as long as the pharmacy and facility staff have a policy and procedure in place to prevent medication that is discontinued or otherwise unneeded from being billed to MO HealthNet. Cycle-fill medication that does not follow the policy and procedure between the pharmacy and facility may be subject to administrative action. (D) Any prescription filled without a request from a participant or the participant’s responsible party may be subject to recoupment. Any provider who pursues an automatic refill policy may be subject to administrative action. AUTHORITY: sections 208.153, 208.201, and 660.017, RSMo 2016.* Original rule filed Dec. 15, 2022, effective July 30, 2023. Amended: Filed Nov. 6, 2023, effective May 30, 2024. *Original authority: 208.153, RSMo 1967, amended 1967, 1973, 1989, 1990, 1991, 2007, 2012; 208.201, RSMo 1987, amended 2007; and 660.017, RSMo 1993, amended 1995. 13 CSR 70-20.045 Maximum Day Supply Limit on Prescriptions Reimbursed by the MO HealthNet Division PURPOSE: This rule establishes a thirty-one- (31-) day supply maximum restriction per dispensing on prescriptions reimbursed by the MO HealthNet Division (MHD). PUBLISHER’S NOTE: The secretary of state has determined that publication of the entire text of the material that is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here. (1) The maximum days’ supply for prescriptions dispensed on behalf of a participant eligible for any fee-for-service programs is a maximum of thirty-one (31) days, except for those prescriptions under the provisions of this rule. MHD providers may dispense prescriptions in quantities less than a thirty-one- (31-) day supply if ordered by the prescriber, except as specified elsewhere in this rule. (2) Prescriptions that are exempt from the thirty-one- (31-) day supply limit and therefore may be dispensed in quantities exceeding a thirty-one- (31-) day supply are made available in the MHD Pharmacy Manual. The MHD Pharmacy Manual is incorporated by reference in this rule as published by the Department of Social Services, MO HealthNet Division, 615 Howerton Court, Jefferson City, MO 65109, April 15, 2024. This rule does not incorporate any subsequent amendments or additions. The division reserves the right to effectuate changes in the list of prescriptions and categories exempt from the thirty-one- (31-) day supply limit by amending this rule. (3) All spend down participants are exempt from the MHD thirty-one- (31-) day supply limit on pharmacy services. (4) Exemptions from the thirty-one- (31-) day supply limit may be given with prior authorization by the MHD to prevent a higher level of care. (5) Prescriptions identified by 13 CSR 70-20.047 are exempt from the thirty-one- (31-) day supply limit. AUTHORITY: sections 208.201 and 660.017, RSMo 2016, and sections 208.152 and 208.153, RSMo Supp. 2024.* Emergency rule filed Nov. 21, 2000, effective Dec. 1, 2000, expired May 29, 2001. Original rule filed June 29, 2000, effective Feb. 28, 2001. Amended: Filed Dec. 5, 2000, effective June 30, 2001. Amended: Filed April 18, 2018, effective Nov. 30, 2018. Amended: Filed Jan. 15, 2021, effective July 30, 2021. Amended: Filed Oct. 23, 2024, effective May 30, 2025. *Original authority: 208.152, RSMo 1967, amended 1969, 1971, 1972, 1973, 1975, 1977, 1978, 1978, 1981, 1986, 1988, 1990, 1992, 1993, 2004, 2005, 2007, 2011, 2013, 2014, 2015, 2016, 2018, 2021, 2023, 2024; 208.153, RSMo 1967, amended 1967, 1973, 1989, 1990, 1991, 2007, 2012, 2024; 208.201, RSMo 1987, amended 2007; and 660.017, RSMo 1993, amended 1995. 13 CSR 70-20.047 Ninety-Day Supply Requirement for Select Prescriptions PURPOSE: This rule establishes a ninety- (90-) day supply requirement per dispensing on select prescriptions reimbursed by the MO HealthNet Division (MHD) on behalf of participants eligible for MO HealthNet. PUBLISHER’S NOTE: The secretary of state has determined that publication of the entire text of the material that is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here. (1) MHD participating pharmacies shall dispense a ninety- (90-) day supply of select prescriptions to a participant eligible for fee-for-service programs. Prescriptions subject to this ninety- (90-) day supply requirement are included in the 90-Day Supply Medication List, and incorporated by reference and made part of this rule as published by the Department of Social Services, MO HealthNet Division, 615 Howerton Court, Jefferson City, MO 65109, at its website at https://mydss.mo.gov/media/pdf/90-day-supply-medication-list-1, November 15, 2021. This rule does not incorporate any subsequent amendments or additions. AUTHORITY: sections 208.201 and 660.017, RSMo 2016, and sections 208.152 and 208.153, RSMo Supp. 2024.* Original rule filed Jan. 15, 2021, effective July 30, 2021. Amended: Filed Sept. 9, 2024, effective April 30, 2025. *Original authority: 208.152, RSMo 1967, amended 1969, 1971, 1972, 1973, 1975, 1977, 1978, 1978, 1981, 1986, 1988, 1990, 1992, 1993, 2004, 2005, 2007, 2011, 2013, 2014, 2015, 2016, 2018, 2021, 2023, 2024; 208.153, RSMo 1967, amended 1967, 1973, 1989, 1990, 1991, 2007, 2012, 2024; 208.201, RSMo 1987, amended 2007; and 660.017, RSMo 1993, amended 1995. 13 CSR 70-20.050 Return of Drugs PURPOSE: This rule establishes that pharmacies must give the MO HealthNet Division credit for any unused portion of the drug that is reusab l e i n a c c o r d a n c e w i t h a p p l i c a b l e f e d e r a l o r s t a t e l a w . ( 1 ) T h e r e t u r n a n d r e u s e o f d r u g s m u s t f o l l o w g u i d e l i n e s s e t b y t h e S t a t e B o a r d o f P h a r m a c y i n 2 0 C S R 2 2 2 0 - 3 . 0 4 0 , a s a m e n d e d . ( 2 ) T h e p h a r m a c y m u s t g i v e t h e M O H e a l t h N e t D i v i s i o n c r e d i t f o r a l l r e u s a b le items (any unused portion) not taken by the MO HealthNet participant. In instances in which charges have been submitted prior to the return of an item, the pharmacy shall file an adjustment prorated to the quantity of the drug used by the MO HealthNet participant. AUTHORITY: sections 208.153, 208.201, and 660.017, RSMo 2016.* Original rule filed Dec. 15, 2000, effective July 30, 2001. Amended: Filed Sept. 16, 2013, effective March 30, 2014. Amended: Filed April 18, 2018, effective Nov. 30, 2018. Amended: Filed May 28, 2021, effective Nov. 30, 2021. *Original authority: 208.153, RSMo 1967, amended 1973, 1989, 1990, 1991, 2007, 2012; 208.201, RSMo 1987, amended 2007; and 660.017, RSMo 1993, amended 1995. 13 CSR 70-20.060 Professional Dispensing Fee PURPOSE: The MO HealthNet Division establishes the amount of the fee reimbursable for the professional dispensing of each MO HealthNet covered prescription by a pharmacy provider. PUBLISHER’S NOTE:  The secretary of state has determined that the publication of the entire text of the material which is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive.  This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here. (1) Between April 1, 2017 and January 31, 2021, a prof e s s i o n a l d i s p e n s i n g f e e s h a l l b e a d d e d t o t h e M O H e a l t h N e t m a x i m u m a l l o w a b l e p a y m e n t f o r M O H e a l t h N e t r e i m b u r s a b l e p r e s c r i p t i o n s f i l l e d o r r e f i l l e d b y a p h a r m a c y p r o v i d e r a s f o l l o w s : ( A ) O u t - o f - s t a t e p h a r m a c y p r o v i d e r s r e c e i v e a p r o f e s s i o n a l d i s p e n s i n g fee of nine dollars fifty-five cents ($9.55); (B) In-state pharmacy providers receive a professional dispensing fee of fourteen dollars thirty-seven cents ($14.37); (C) In-state pharmacy providers receive a preferred generic product incentive fee of five dollars zero cents ($5.00); and (D) The professional dispensing fees as provided in this rule shall not be included in the computation of the MO HealthNet maximum allowable drug payment for participant cost-sharing purposes. (2) Effective February 1, 2021, a professional dispensing fee shall be added to the MO HealthNet maximum allowable payment for MO HealthNet reimbursable prescriptions filled or refilled by a pharmacy provider as follows: (A) Out-of-state pharmacy providers receive a professional dispensing fee of eight dollars and eighty-five cents ($8.85); (B) In-state pharmacy providers receive a professional dispensing fee of twelve dollars and twenty-two cents ($12.22), plus an adjustment to account for the costs of the Missouri Pharmacy Reimbursement Allowance attributable to Medicaid-reimbursed prescriptions; (C) The professional dispensing fee as provided in this rule shall not be added to prescriptions reimbursed at the usual and customary charge submitted by the provider; and (D) The professional dispensing fees as provided in this rule shall not be included in the computation of the MO HealthNet maximum allowable drug payment for participant cost-sharing purposes. (3) Effective April 1, 2017, all pharmacy providers supplying prescribed MO HealthNet covered drugs to participants in long-term care facilities shall receive an additional fifty cent (50¢) dispensing fee per claim provided they— (A) Dispense medication in a drug distribution system(s) which meets minimum standards of container packaging (at least class B as defined in United States Pharmacopeia XXI); (B) Certify to the MO HealthNet Division, on a form, and in the manner prescribed by the division, that they— 1. Provide this dispensing service to their long-term care facility resident patients; 2. Provide emergency services twenty-four (24) hours a day with seven (7) days a week availability; and 3. Have the ability and willingness to assist in accessing medications through the MO HealthNet Exception Process; and (C) Indicate, as prescribed by the MO HealthNet Division, on each claim that the prescription was provided in packaging qualifying for the dispensing fee add-on to a participant in a long-term care facility. (4) A professional dispensing fee shall be added to maintenance medications no more frequently than once every twenty-five (25) days. “Maintenance medications” are defined as drugs that have a common indication for treatment of a chronic disease, and the therapeutic duration is expected to exceed one year. This is determined by a First DataBank drug code maintenance indicator of “1.” AUTHORITY: sections 208.153, 208.201, and 660.017, RSMo 2016.* Original rule filed Dec. 15, 1987, effective March 11, 1988. Amended: Filed Sept. 26, 2013, effective March 30, 2014. Emergency amendment filed Jan. 13, 2021, effective Feb. 1, 2021, expired July 30, 2021. Amended: Filed Jan. 13, 2021, effective July 30, 2021. *Original authority: 208.153, RSMo 1967, amended 1973, 1989, 1990, 1991, 2007, 2012; 208.201, RSMo 1987, amended 2007; and 660.017, RSMo 1993, amended 1995. 13 CSR 70-20.070 Drug Reimbursement Methodology PURPOSE: This rule establishes the basis and the method for pricing all drug claims in Missouri under the Title XIX Medicaid program. The purchase of a computer-generated tape, with weekly updates, will make it possible to utilize the computer for review purposes, which greatly increases the speed with which claims can be paid. (1) The MO HealthNet Division will obtain, by contract with a reputable medical publishing company, a weekly computer-generated tape which will provide the information needed to price all fee-for-service Medicaid drug claims. The tape will contain National Drug Code (NDC), drug name, drug strength, dosage form, package size, the prices set by direct-selling manufacturers (direct prices), Wholesaler Acquisition Cost (WAC), federal Health and Human Services upper limits for specified multiple source drugs (FUL), and National Average Drug Acquisition Cost (NADAC). A multiple source drug is defined as a drug marketed or sold by two (2) or more manufacturers or labelers, or a drug marketed or sold by the same manufacturer or labeler under two (2) or more different proprietary names or both under a proprietary name and without that name. (2) The MO HealthNet Division will add the Missouri Maximum Allowable Cost (MMAC) limits, for multiple source drugs as defined, to the data shown on the tape described in section (1) of this rule. (3) Effective December 16, 2018, reimbursement for covered drugs will be determined by applying the following hierarchy method: (A) National Average Drug Acquisition Cost (NADAC); if there is no NADAC; (B) Missouri Maximum Allowed Cost (MAC); if no NADAC or MAC; (C) Wholesale Acquisition Cost (WAC); or (D) T h e u s u a l a n d c u s t o m a r y ( U &