Frequently Asked Questions

Pharmacist

• How do I contact Medicare's Pharmacy Hotline?

  Medicare's Pharmacy Hotline is toll free 1-866-835-7595

• What number do I call for questions with processing MoRx claims?

  Call (573) 751-6963

• What is the Missouri Rx Plan (MoRx) BIN/PCN? Where should I send the Part D coordination of benefits (COB) claims?

  Use the following BIN/PCN when submitting claims to MoRx: 004047/P021011511

• Where should I send Medicare Part D excluded drug claims for dual eligibles?

  Use the following BIN/PCN when submitting excluded drug claims for dual eligibles: 004047/P021011511

• Where should I send Medicare Part D excluded drug claims for MO HealthNet only participants?

  Use the following BIN/PCN when submitting excluded drug claims for MO HealthNet only participants: 004047/43-1754897

• What is MoRx's group ID?

  A group ID number is not required. BIN/PCN and member ID are the only information needed to process a claim.

• What do I use for the member's MoRx ID number?

  The member's Medicare claim number is their MoRx member ID number. The Medicare claim number is printed on their Medicare health insurance card. This number is also commonly referred to as the HICN.

• What medications are covered?

  MoRx pays toward the out-of-pocket cost of the formulary of the Medicare Part D plan. Any prescription drug covered by a member's Medicare Part D plan will also be covered by MoRx. For dual eligible members, Part D excluded drugs will continue to be covered.

• Will specific Part D plan information appear for the dual eligibles the same way that a primary plan will show for a fee for service participant when pharmacies are billing MO HealthNet?

  No, but the Part D plan information will be available to the pharmacies through an E-1 transaction.

• How can people enroll in MoRx?

  All dual eligibles are automatically enrolled in MoRx. Enrollment is open year-round for other income eligible Medicare beneficiaries. Learn more about enrolling in MoRx.

• Will MoRx work with mail order pharmacies?

  No. MoRx does not work with mail order pharmacies. MoRx will provide wrap-around benefits for covered prescriptions purchased at any non-mail order pharmacy that is contracted with MO HealthNet and with the member's Part D plan.

• Will MoRx process paper claims?

  MoRx only accepts claims that are submitted electronically and cannot accept paper claims submissions.

• Will the MoRx benefit apply to the purchase of a 90-day supply of medication?

  No. The MoRx benefit will not cover a 90-day supply of medication. The MoRx benefit will cover up to a 31-day supply of each prescription at a time.

• Are there Part D plans set up specifically for Long Term Care (LTC) patients to ensure LTC pharmacies will be reimbursed for bubble packaging, delivery service, emergency boxes and drug disposition?

  No. All LTC pharmacies in a region need to negotiate terms and conditions with as many plans as possible or risk losing business to another more competitive LTC pharmacy. Part D plans are encouraged to work with all LTC pharmacies so that all of the Part D plan enrollees can get prescriptions.

• If a participant has Medicare Parts A and B and is eligible for MO HealthNet under Blind Pension (ME Code 02), must they enroll in a Part D plan? Will MO HealthNet continue paying for their prescription drugs?

  Blind Pension participants (ME Code 02) do not have to enroll in a Part D plan. MO HealthNet will continue paying for their prescription drugs. Other ME codes that are likewise exempt from the Part D requirement are 08, 09, 57, 59, 64 and 65.

• Will co-pays need to be collected for Medicare Part D?

  Medicare Part D co-pays are real co-pays. Unlike MO HealthNet co-pays, providers may refuse service if a patient does not pay their Medicare Part D co-pay.