Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 20 - Pharmacy Program › Section 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

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment updates language in section
				  (1) to add exclusions and definition for abortifacient drugs or devices, and
				  revises sections (2) and (5).
(1) Exclusions-As used in section
				208.152.1(12), RSMo, any "abortifacient drug or device" includes: mifepristone
				when used to induce an abortion; misoprostol when used to induce an abortion;
				manual vacuum aspirator (MVA) when used to induce an abortion; or any 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
				specified indications, and those which are excluded from reimbursement through
				the MO HealthNet Pharmacy Program shall be made available through-
(A) MO HealthNet provider manuals, 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/
,
				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/presen-tation/forms.jsp
,
				September 27, 2018. This rule does not incorporate any subsequent amendments or
				additions.