MAK-AIRS

Missouri Rx Changes Effective July 1, 2017.

Missouri Rx has been reauthorized by legislature for another 5 years until August, 28, 2022. This reauthorization has come at a cost. Eligibility for MO Rx has been decreased to only those that have Medicaid dual eligibility. Those that still qualify for MO Rx benefits are Medicare Part D plan or Advantage plan enrollees with:

• Full Medicaid (MO HealthNet) Benefits
• A Medicare Saving Program – QMB, SLMB and QI-1 (SLMB Group 2)

Those with an open Missouri Spend Down Case :

1. If they have met or paid in their spend down– MO Rx will pay 50% of the co-pays $3.30 – generics and $8.25 – name brand medications
2. If a person has not met or paid in the spenddown amount, Missouri Rx will pay up to $4.13 per prescription.

Missouri Rx coverage will no longer provide benefits for those with:

• Medicare with Extra Help from SSA or Low Income Subsidy.
• Medicare Part D or Advantage coverage only

This group includes about 64,000 enrollees currently. This will be the group that is hit the hardest by this new set of rules. MO Rx has been paying 50% of their cost sharing on all covered medications until now.

The loss of eligibility for the State Pharmacy Assistance Program does quality a person for a Special Enrollment Period to join or switch to another Medicare Part D plan or Medicare Advantage Plan with drug coverage. The SEP starts the month you lose the SPAP (MORx) because you are no longer eligible or are notified of the loss (whichever comes first) and continuing for two months after you are notified of the loss or lose the SPAP (whichever comes later). The new coverage would begin for first day of the month after you submit a completed application.