MO HealthNet Pharmacy Updates PDL List For Proposed Regulation Change

MO HealthNet is planning a proposed regulation change to carve out drugs on the preferred drug list for 340B entities. The go-live timeframe for this regulation change is still being evaluated by MO HealthNet. This carve out would operate the same as existing carve outs, meaning that claims submitted for a preferred PDL product with a 340B indicator or modifier would be denied.

Claims without the 340B indicator or modifier will pay at the standard MO HealthNet pharmacy hierarchy. Claims for drugs that are non-preferred on the PDL and claims for drugs not part of the PDL would still be able to utilize 340B stock.

The full PDL list as of June 25 can be found in an Excel sheet or a searchable database. Please note that the PDL list is “proprietary of the State of Missouri, MO HealthNet Division. All information is deemed reliable as of the date of the document, but not guaranteed.”

The proposed regulation language change can be found below.

MO HealthNet Regulation 13 CSR 70-20.075 – 340B Drug Pricing Program

Full regulation can be found here.

Proposed Regulation Change:

(6) MHD may carve-out certain medications and categories of medications from 340B participation for MHD reimbursement. Medications subject to the carve-out will be reimbursed according to 13 CSR 70-20.070. The following medications and categories of medications are carved-out of reimbursement through the 340B program:

(A) (Drugs approved by the FDA for the treatment of obesity) All preferred agents on the Preferred Drug List (PDL) on the date of service; and

(B) Cell and gene therapies