Missouri Code of State Regulations
Title 13 - DEPARTMENT OF SOCIAL SERVICES
Division 70 - MO HealthNet Division
Chapter 100 - Missouri Rx Plan
Section 13 CSR 70-100.010 - Missouri Rx Plan Benefits and Limitations
Universal Citation: 13 MO Code of State Regs 70-100.010
Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: The purpose of this amendment is to update the rule to reflect the current program processes.
PURPOSE: This rule establishes the benefits and limitations for administering the Missouri Rx Plan and Missouri's State Pharmacy Assistance Program.
(1) Administration. The Missouri Rx Plan shall be administered by the Department of Social Services, MO HealthNet Division.
(2) Definitions.
(A) Dual eligible-An individual who is
eligible for both Medicare and Medicaid.
(B) Missouri Rx Plan-The state pharmacy assistance
program administered by the Department of Social Services, MO HealthNet
Division.
(C) Out-of-pocket costs-
The co-pays required for prescription drug. The Missouri Rx Plan does not pay
for the Medicare Part D monthly premium.
(3) Individuals who are enrolled in Medicare and MO HealthNet (dual eligibles) are deemed to have enrolled in the Missouri Rx Plan.
(4) Benefit Limits.
(A) The Missouri Rx Plan shall pay fifty
percent (50%) of the member's out-of-pocket costs for prescription drugs
covered by the Medicare Prescription Drug Program and by the members Medicare
Part D Plan formulary.
(B) Members
with a MO HealthNet spenddown requirement must meet the spenddown at least once
during the calendar year for the Missouri Rx Plan to pay fifty percent (50%) of
the member's out-of-pocket costs.
(C) The Missouri Rx Plan shall have the authority to
change the benefit limits at any time to achieve program cost control.
(5) Termination from the Program.
(A) A member shall be terminated
from the Missouri Rx Plan if he or she no longer meets the MO HealthNet or
Medicare eligibility requirements
Disclaimer: These regulations may not be the most recent version. Missouri may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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