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 Missourians in need by coordinating benefits with Medicare's (Part D) Prescription Drug Program. Individuals receiving Medicare and a MO HealthNet benefit are eligible for MORx coverage and automatically enrolled in the program.
What are the MORx benefits?
- MORx works with all Medicare Part D plans.
- MORx pays for 50% of the member's out-of-pocket costs on medications that are covered by the member's Medicare Part D plan. If a member has a Medicaid spend-down requirement, the spend-down must be met at least once during the calendar year for MORx benefits to work. When a member meets the spend-down requirement one time, MORx will start paying 50% toward the medication cost.
- MORx uses the formulary of the Medicare Part D plan. If the member’s Part D plan does not cover a drug, MORx will not cover it.
- MORx members will continue to have coverage for Medicare-excluded drugs through MO HealthNet. Medicare-excluded drugs include specific over-the-counter drugs, vitamins, minerals, and limited cough and cold drugs.
- MORx covers up to a 31-day supply for each prescription.
- Members can use any Missouri pharmacy that works with their Part D plan. (MORx does not cover mail-order services)
Is there a cap or maximum payment amount on these benefits?
Does MORx pay toward my Medicare Part D Plan premium?
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 not covered?
Compound drugs are not covered by MORx.
Are brand and generic drugs covered?
Yes, as long as they are covered by the Part D plan.
What is Medicare Part D excluded drugs?
Medicare Part D excluded drugs include specific over-the-counter drugs such as vitamins, minerals, and limited cough and cold drugs. MORx members 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. Members can fill their prescriptions at any non-mail-order pharmacy that is contracted with their 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?
No, MORx members will not receive a membership card.
How will my pharmacy know about my MORx membership and benefit?
You will need to notify your pharmacy that you are a MORx member and provide them with a copy of your red, white, and blue Medicare card. Your MORx member ID will be the MBI number found on your Medicare card.
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: 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.
What changed in my MO HealthNet coverage when I became eligible for MORx?
Only the pharmacy benefit changes. You will receive pharmacy benefits through your Medicare Part D plan and MORx.
If Medicare Part D does not cover a drug and the drug is not a Medicare Part D excluded drug, will MO HealthNet pay for the drug?
If a participant has Medicare Parts A and B, and is eligible for MO HealthNet under Blind Pension, do they need to enroll in a Part D plan? If they do not enroll in a Part D plan and later lose their blind pension, will they have to pay a late enrollment penalty?
Yes. Individuals eligible for Blind Pension must enroll in a Part D plan.
What are the Medicare co-pays?
Medicare co-pays for 2021 should not exceed $ 3.30 for generic and $ 9.20 for brand name prescriptions.
Are Medicare co-pays required for participants in Long Term Care?
After the first full month of residence in a skilled nursing facility, an intermediate care facility for the mentally retarded, or an inpatient psychiatric hospital, participants will have no co-pay.
What are the Medicare co-pays for dual eligibles in Residential Care Facilities (RCF)?
Medicare co-pays in 2021 should not exceed $ 3.30 for generic and $ 9.20 for brand name prescriptions.
Do I have to pay the Medicare co-pays?
MORx will pay for half of the Medicare co-pay, but you will need to pay the rest. Medicare Part D co-pays are real co-pays. Unlike MO HealthNet co-pays, your pharmacy may refuse you service if you do not pay your portion of the co-pay.
If a participant does not enroll in a Medicare Part D plan, will MO HealthNet pay for Part D drugs?
No. Participants must enroll in a Part D plan for their prescription benefits.
Will MO HealthNet pay for any Medicare Part B drugs for participants?
Yes, MO HealthNet does pay the deductible and coinsurance amounts otherwise charged to the participant for Medicare Part B drugs.
If a participant is receiving their diabetic supplies and nebulizer drugs from a mail-order pharmacy, do they need to change?
Medicare Part B covers these products and the participant may continue to get these through the Part B provider if they are also a MO HealthNet provider.
Who will cover Blood Glucose Test Strips?
Medicare Part B covers Blood Glucose Test Strips and the participant may continue to get these supplies through the Part B provider. MO HealthNet will pay the deductible and coinsurance amounts from Medicare Part B.
How will OTC medications be covered for participants who have no spend-down?
MO HealthNet will continue to pay for drugs excluded from Medicare Part D coverage, including certain over-the-counter medications for dual eligibles. Claims for these drugs will need to meet current MO HealthNet edits.
Will I still have to pay my spend-down every month, since MO HealthNet will no longer be covering my prescriptions?
Yes, if medical services other than prescription drugs are required.
For residential care facility (RCF) residents with an income that is higher than the facility rate and who are MO HealthNet spend-down clients, can they apply and prepay their spend-down and be eligible for the entire month?
Yes. If a participant prepays their spend-down, they are eligible for the entire month and MO HealthNet will cover their Part D excludable drugs for the entire month.
How does spend-down affect Medicare Part D drug costs?
If you have a Medicaid spend-down requirement, the spend-down must be met at least once during the calendar year for MORx benefits to work. When you meet the spend-down requirement one-time MORx will start paying 50% toward your medication cost.
If I am a participant enrolled in Medicare Part D, but I have not met my spend-down yet this month, will excludable drugs be covered by MO HealthNet?
No, but the cost of the excludable drugs will count toward spend-down.
Do drugs not on the Medicare Part D formulary count toward spend-down?
Yes, if they are prescribed by a physician.
Will Medicare Part D premiums count toward spend-down?
If the participant pays the premiums, this amount will count toward their spend-down.
Since MO HealthNet is not covering my prescriptions any longer, will the amount of my spend-down be reduced?