SB 490 - This act requires the MO HealthNet Division to establish a program under which the fee for service component of MO HealthNet shall reimburse terminal distributors of prescription drugs for providing critical access medication management to critical prescription access patients at a rate no less than $25 per person per month. The Division shall also conduct prior authorization of critical prescription access patients electronically and provide the prior authorization for the patient for all prescription drugs, rather than a specific prescription drug. Prior authorization shall not be required more frequently than once every six months. Additionally, the Division shall specify the critical access medication management services to be provided by a terminal distributor of prescription drugs in order to receive treatment. The MO HealthNet Division shall also contract or amend existing contracts with managed care organizations to require that managed care organizations provide critical access medication management to critical prescription access patients at a rate no less than $25 per month per person. Managed care organizations shall also conduct prior authorization of critical prescription access patients electronically and provide the prior authorization for the patient for all prescription drugs, rather than a specific prescription drug. Prior authorization shall not be required more frequently than once every six months. Additionally, the managed care organizations shall provide critical access medication management services as specified by the Division. The Division shall enter into new contracts or amend existing ones with managed care organizations pursuant to these provisions no earlier than July 1, 2016, and no later than six months following final approval of waivers or state plan amendments submitted to the Centers for Medicare and Medicaid Services.
Critical prescription access patients are those MO HealthNet participants who have been diagnosed with, and receiving treatment for, HIV, cancer, or a severed and persistent mental illness, and who require the following treatment: (1) not less than 5 types of prescription drugs per month; (2) specialized, adherence, or compliance packaging for prescription drugs; and (3) multiple dispensing of prescription drugs per month.
SARAH HASKINS