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.