Professional Dispensing Fee

PURPOSE: The MO HealthNet Division establishes the amount of the fee reimbursable for the professional dispensing of each MO HealthNet covered prescription by a pharmacy provider. 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) Between April 1, 2017 and January 31, 2021, a professional dispensing fee shall be added to the MO HealthNet maximum allowable payment for MO HealthNet reimbursable prescriptions filled or refilled by a pharmacy provider as follows: (A) Out-of-state pharmacy providers receive a professional dispensing fee of nine dollars fifty-five cents ($9.55); (B) In-state pharmacy providers receive a professional dispensing fee of fourteen dollars thirty-seven cents ($14.37); (C) In-state pharmacy providers receive a preferred generic product incentive fee of five dollars zero cents ($5.00); and (D) The professional dispensing fees as provided in this rule shall not be included in the computation of the MO HealthNet maximum allowable drug payment for participant cost-sharing purposes. (2) Effective February 1, 2021, a professional dispensing fee shall be added to the MO HealthNet maximum allowable payment for MO HealthNet reimbursable prescriptions filled or refilled by a pharmacy provider as follows: (A) Out-of-state pharmacy providers receive a professional dispensing fee of eight dollars and eighty-five cents ($8.85); (B) In-state pharmacy providers receive a professional dispensing fee of twelve dollars and twenty-two cents ($12.22), plus an adjustment to account for the costs of the Missouri Pharmacy Reimbursement Allowance attributable to Medicaidreimbursed prescriptions; (C) The professional dispensing fee as provided in this rule shall not be added to prescriptions reimbursed at the usual and customary charge submitted by the provider; and (D) The professional dispensing fees as provided in this rule shall not be included in the computation of the MO HealthNet maximum allowable drug payment for participant cost-sharing purposes. (3) Effective April 1, 2017, all pharmacy providers supplying prescribed MO HealthNet covered drugs to participants in long-term care facilities shall receive an additional fifty cent (50¢) dispensing fee per claim provided they— (A) Dispense medication in a drug distribution system(s) which meets minimum standards of container packaging (at least class B as defined in United States Pharmacopeia XXI); (B) Certify to the MO HealthNet Division, on a form, and in the manner prescribed by the division, that they— 1. Provide this dispensing service to their long-term care facility resident patients; 2. Provide emergency services twenty-four (24) hours a day with seven (7) days a week availability; and 3. Have the ability and willingness to assist in accessing medications through the MO HealthNet Exception Process; and (C) Indicate, as prescribed by the MO HealthNet Division, on each claim that the prescription was provided in packaging qualifying for the dispensing fee add-on to a participant in a long-term care facility. (4) A professional dispensing fee shall be added to maintenance medications no more frequently than once every twenty-five (25) days. “Maintenance medications” are defined as drugs that have a common indication for treatment of a chronic disease, and the therapeutic duration is expected to exceed one year. This is determined by a First DataBank drug code maintenance indicator of “1.” AUTHORITY: sections 208.153, 208.201, and 660.017, RSMo 2016.* Original rule filed Dec. 15, 1987, effective March 11, 1988. Amended: Filed Sept. 26, 2013, effective March 30, 2014. Emergency amendment filed Jan. 13, 2021, effective Feb. 1, 2021, expired July 30, 2021. Amended: Filed Jan. 13, 2021, effective July 30, 2021. *Original authority: 208.153, RSMo 1967, amended 1973, 1989, 1990, 1991, 2007, 2012; 208.201, RSMo 1987, amended 2007; and 660.017, RSMo 1993, amended 1995.