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Missouri Rx Plan - State Pharmacy Assistance Program

Page Reviewed / Updated - Mar. 2019

Table of Contents


Program Description

Missouri's State Pharmacy Assistance Program is more commonly referred to as the Missouri Rx Plan or MORx. This program assists low income seniors with the cost of their medications by paying up to 50% of their co-payment, deductible, and coverage gap amounts. The MORx Program is intended to supplement Medicare Part D (Medicare’s prescription drug program) plans, not to replace them. When an enrolled individual makes a medication purchase, Medicare Part D is the "first payer" and MORx is the "second payer," meaning the Missouri Rx Plan will only pay after Medicare Part D has paid their portion.

As of June 30, 2017, Medicare only individuals were no longer eligible for this prescription assistance program. MORx is only available for those who are dually eligible for Medicaid and Medicare.

Did You Know?  Relative to the state's median income, Missouri has some of the most, if not the most, affordable assisted living in the nation. 

Eligibility Guidelines

To be eligible for this program, seniors must meet the following criteria:

  • Be a Missouri resident and intend to remain a resident.
  • Be at least 65 years of age or designated as disabled by Social Security.
  • Be enrolled in or willing to enroll in a Medicare Part D Plan.
  • Be enrolled in or willing to enroll in a Medicaid or a Medicaid spend down program.
  • Have monthly income below the limit. As of 2019, a single individual must have a monthly income below $1,805 ($21,660 / year) and a married couple must have a monthly income under $2,428 ($29,140 / year).

Note that persons enrolled in or eligible for the Missouri Medicaid (MO HealthNet) prescription program cannot concurrently receive assistance under this program.

Benefits and Services

MORx will pay for 50% of participants' out-of-pocket prescription costs (deductibles, copayments, and coverage gap) on prescriptions covered by a participant’s Medicare Part D Plan. Some drugs that are not covered by Medicare are also covered. These include vitamins, certain over-the-counter drugs, and benzodiazepines.

Make note, this program does not assist in covering the cost of Medicare Part D Plan premiums. Nor does it have enrollment or application fees. However, some participants perceive an added cost since they are required to enroll in a Medicare Part D plan, which they might otherwise have chosen not to do. In addition, some participants have an annual Medicaid spend down that they must meet in order for MORx benefits to kick in.

How to Apply / Learn More

In order to be eligible for this program, one must be a Medicaid participant. If one is not currently on Medicaid, one needs to apply. One can call the MO HealthNet Family Support Division at 855-373-4636 for additional information or to apply. 

Visit the Missouri Department of Social Services Rx Plan webpage for more information or to apply for the program. Once an applicant is enrolled in this program, there is no need to reapply.

The state of Illinois has two programs designed to provide financial assistance to the elderly to help them purchase their prescription drugs. Rx Basic is for individuals without Medicare insurance and the Rx Plus is designed for those on Medicare.

 

Rx Plus is known as a Medicare wraparound program which means the benefits wrap around those benefits provided by a Medicare Part D plan. When making a prescription purchase, Medicare Part D is the first payer and then this program contributes towards those costs the Part D plan does not cover.