Pharmacy Program by MO HealthNet
While the three managed care plans (Home State Health, Missouri Care, and United Healthcare) may have different provider networks for behavioral health and medical care services (e.g., physicians, hospitals, labs), all use the same program for prescription medications -- the Pharmacy Program by MO HealthNet. Members of MO HealthNet's Fee-For-Service Program receive their prescription medication benefits this way as well. Health insurance and policy experts may refer to this model as a pharmacy carve-out.
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CONNECT
Pharmacy Program Service Support for School Nurses If you have questions or concerns about medication access for a student enrolled in any type of MO HealthNet program (managed care or fee-for-service), you have two options for assistance:
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SPECIAL ANNOUNCEMENTS AND PROGRAM INFO
SECOND INHALER BENEFIT -- FOR STUDENTS WITH ASTHMA. Effective December 1, 2017. Students with asthma are able to obtain a second inhaler from the Pharmacy Program by MO HealthNet. An extra inhaler could be kept at school, at a second house where a student lives during the week, etc. MO HealthNet is distributing letters to parents of children with asthma about this special benefit and notifying physicians and pharmacists as well. If you have a student who could benefit from access to a second inhaler, contact the Pharmacy Program Service Support Line for School Nurses at (800) 392-8030, option #3. Parents/guardians may also call this number and request assistance directly.
COMMON QUESTIONS
Are co-payments required? (Very small amounts for adults, but none for children)
Medication costs for MO HealthNet members are very low; copays are usually just $1-$2, but members under age 19 do not pay co-payments at all. A provider cannot refuse service to a patient if they do not have the co-payment. However, if it is the routine business practice of the provider to discontinue future services to an individual with an uncollected debt, the provider may include uncollected copayments under this practice. In this case, the provider does not have to see a patient.
Which medications are available?
The Pharmacy Program by MO HealthNet has had to take steps to deal with the increasing cost of drugs. As other insurance companies have done, MO HealthNet is now using a “Preferred Drug List” (PDL) to save money. Some drugs on the PDL can be filled by the pharmacy without taking any extra steps, but some some drugs may require the doctor or pharmacist to make a special request before it is filled. Click here to view the Preferred Drug List.
Can a student get access the Pharmacy Program without being in enrolled in MO Health Net's fee-for-service or managed care plans?
No. The Pharmacy Program is limited to the enrollees of MO HealthNet. Visit the Get Coverage page on this site for more guidance about the MO Health Net enrollment process.
Are co-payments required? (Very small amounts for adults, but none for children)
Medication costs for MO HealthNet members are very low; copays are usually just $1-$2, but members under age 19 do not pay co-payments at all. A provider cannot refuse service to a patient if they do not have the co-payment. However, if it is the routine business practice of the provider to discontinue future services to an individual with an uncollected debt, the provider may include uncollected copayments under this practice. In this case, the provider does not have to see a patient.
Which medications are available?
The Pharmacy Program by MO HealthNet has had to take steps to deal with the increasing cost of drugs. As other insurance companies have done, MO HealthNet is now using a “Preferred Drug List” (PDL) to save money. Some drugs on the PDL can be filled by the pharmacy without taking any extra steps, but some some drugs may require the doctor or pharmacist to make a special request before it is filled. Click here to view the Preferred Drug List.
Can a student get access the Pharmacy Program without being in enrolled in MO Health Net's fee-for-service or managed care plans?
No. The Pharmacy Program is limited to the enrollees of MO HealthNet. Visit the Get Coverage page on this site for more guidance about the MO Health Net enrollment process.
Note: Information on this page has been reviewed by MO HealthNet.