PURPOSE: This rule establishes a thirty-one- (31-) day supply maximum restriction per dispensing on pharmacy services reimbursed by the MO HealthNet Division on behalf of participants eligible for any of the fee-for-service programs.

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. (1) The maximum days’ supply of medication that may be provided per dispensing on behalf of a participant eligible for any of the fee-for-service programs is thirty-one (31) days, except for those drugs and/or categories under the provisions of this rule. Medication may be dispensed in quantities less than a thirty-one- (31-) day supply, if so ordered by the prescriber, except as specified elsewhere in this rule.
2. (2) Drugs and/or categories of medications that are exempt from the thirty-one- (31-) day supply limitation and therefore may be dispensed in quantities exceeding a thirty-one- (31-) day supply are made available in the MO HealthNet Pharmacy Manual, section 13.6.D(1). The MO HealthNet 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, at its website http://manuals.momed.com/manuals/, October 2, 2020. This rule does not incorporate any subsequent amendments or additions. The division reserves the right to effectuate changes in the list of drugs and/or categories of medications that are exempt from the thirty-one- (31-) day supply limitation by amending this rule.
3. (3) All spend down participants are exempt from the MO HealthNet thirty-one- (31-) day supply maximum restriction on pharmacy services.
4. (4) Exemptions from the thirty-one- (31-) day supply limitation may be given with prior authorization by the MO HealthNet Division to prevent a higher level of care.
5. (5) Drugs and/or categories of medications identified by 13 CSR 70-20.047 are exempt from the thirty-one- (31-) day supply limitation.

AUTHORITY: sections 208.153, 208.201, and 660.017, RSMo 2016, and section 208.152, RSMo Supp. 2020.* 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. *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; 208.153, RSMo 1967, amended 1973, 1989, 1990, 1991, 2007, 2012; 208.201, RSMo 1987, amended 2007; and 660.017, RSMo 1993, amended 1995.