Frequently Asked Questions

MoRx, General Questions

• What is MoRx?

  MoRx is Missouri’s State Pharmacy Assistance Program. MoRx was created by the 93rd General Assembly to provide prescription drug assistance to Missourian’s in need by coordinating benefits with Medicare’s (Part D) Prescription Drug Program.

• How and when do I apply?

  Apply now. Enrollment is open year-round. More information on how you can enroll in MoRx.

• Do I need to apply every year?

  No. Once enrolled, you never need to re-apply. MoRx members may receive a notice to update their information on file with the program, but no re-enrollment is required.

• Is there an enrollment fee or cost associated with becoming a MoRx member?

  No. There is no enrollment fee, monthly premium or deductible.

• Do I qualify for the MoRx Plan benefit?

  You may qualify for MoRx if you are a Missouri resident; enrolled in a Medicare Part D Plan and single — with an annual gross household income of $21,660 or less or married — with an annual income of $29,140 or less.

• Is there an income limit?

  Yes. Income must not exceed $21,660 annual gross income for an individual, or $29,140 annual gross income for a married couple.

• What is annual gross income?

  Annual gross income is all income received by you and your spouse, if married. This is the income you report on your income tax returns before any deductions.

• Is there an asset or resource limit?

  No.

• Am I eligible if I receive benefits from Medicare and MO HealthNet?

  Yes. Individuals who qualify for both Medicare and MO HealthNet benefits will automatically be enrolled into MoRx.

• What are the MoRx benefits?
  • MoRx works with all Medicare Part D plans.
  • MoRx pays for 50% of your out-of-pocket costs on medications that are covered by your Medicare Part D plan. This means you will save 50% on your deductible, 50% on your co-pays and 50% during the coverage gap and beyond. MoRx does not pay for the Medicare Part D Plan’s monthly premium.
  • MoRx uses the formulary of the Medicare Part D plan. Any drug covered by a member’s Part D Plan will also be covered by MoRx.
  • Dual eligible members will continue to have coverage for Medicare-excluded drugs through MO HealthNet. Medicare-excluded drugs include specific over-the-counter drugs, vitamins, minerals, limited cough and cold drugs, benzodiazepines and barbiturates.
  • MoRx covers up to a 31-day supply for each prescription.
  • You can use any Missouri pharmacy that works with your Part D plan. (MoRx does not cover mail order services)
• Is there a cap or maximum payment amount on these benefits?

  No.

• Does MoRx pay toward my Medicare Part D Plan premium?

  No.

• Will MoRx work with any Medicare Part D Plan or Medicare Advantage Prescription Drug Plans?

  Yes. MoRx will work with any approved Medicare Part D Plan including Medicare Advantage Drug Plans.

• What medications are covered?

  MoRx pays toward the medications covered on the Medicare Part D plan’s drug formulary. Any drug covered by a member’s Medicare Part D plan will also be covered by MoRx, except for the Part D excludible drugs.

• What medications are not covered?

  Drugs not covered by a Medicare Part D plan are not covered by MoRx. Medicare Part D excludible drugs are not covered by MoRx.

• Are brand and generic drugs covered?

  Yes, as long as they are covered by the Part D plan and the drug is not a Medicare excludible drug.

• What are Medicare Part D excluded drugs?

  Medicare Part D excluded drugs include benzodiazepines and barbiturates and specific over-the-counter drugs such as, vitamins, minerals, and limited cough and cold drugs. Dual eligible members (eligible for both Medicare and MO HealthNet) will continue to have coverage for these Medicare Part D excluded drugs, provided they meet the MO HealthNet requirements.

• 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. If your doctor writes a prescription for a 90-day supply, simply turn it into your pharmacy and ask them to fill it in 30 or 31 day increments. The MoRx benefit will cover up to a 31-day supply of each prescription at a time. You can get a full day’s prescribed dosage for each day of the month with a maximum of 31 days each month.

• Will my pharmacy work with MoRx?

  Almost all Missouri pharmacies will work with MoRx. You must make sure the Medicare Part D plan you join has your preferred pharmacy in their network of pharmacies.

• Will MoRx work with mail order pharmacies?

  No. MoRx does not work with mail order pharmacies. You can fill your prescriptions at any non-mail order pharmacy that is contracted with your Part D plan and MoRx will provide wrap-around benefits. Many MoRx participating pharmacies provide home delivery services at minimal or no additional charge.

• Will I receive a MoRx membership card?

  Yes. Upon receipt and processing of your completed application, MoRx will mail to you a welcome letter and membership card.

• How will my pharmacy know about my MoRx membership and benefit?

  You will need to show your MoRx membership card to your pharmacy each time you use MoRx.

• How do I contact Medicare? What types of questions can Medicare answer for me?

  You can call 1-800-Medicare (1-800-633-4227) or visit www.medicare.gov. Medicare can answer any questions you may have about your enrollment into a Part D plan, how to change plans or how to disenroll from a Part D plan. Medicare is also your best source for information if you are experiencing problems with your Part D plan.

• How do I choose a Medicare Part D plan? Who can tell me about the different prescription drug plans to find the one that is best for me?

  The best sources for assistance are: Medicare or call 1-800-MEDICARE (1-800-633-4227) and CLAIM at 1-800-390-3330, which provides free health insurance counseling to Medicare participants in Missouri.