Self-administered Hormonal Contraception Medication Without a Prescription
Impacted Plans: Medicaid, HIV SNP, HARP, CHP, MAP, QHP, Gold, GoldCare, & EP
Effective January 1, 2024, Governor Kathy Hochul authorized New York State pharmacists to dispense three types of self-administered hormonal contraception medication without a prescription. These self-administered hormonal contraception medications are approved by the federal Food and Drug Administration to prevent pregnancy and include the following:
- Oral hormonal pill
- Hormonal vaginal ring
- Hormonal contraceptive patch
New York State pharmacists who choose to participate can dispense up to 12 months of a self-administered hormonal contraception at one time pursuant to a non-patient specific order (i.e., a standing order) written by the Commissioner of Health (COH), a physician-licensed, or a nurse practitioner (NP) certified in NYS.
MetroPlusHealth Medicaid, Partnership In Care, and Enhanced (HARP) plan members receive drug benefits through NYRx, the Medicaid Pharmacy Program. Pharmacy providers click here for NYRx billing guidance.
For MetroPlusHealth Child Health Plus, UltraCare, QHP, Gold, GoldCare, & Essential Plans: Pharmacies can bill for the evaluation and management (E&M) associated with the dispensing of self-administered hormonal contraception, pharmacy providers must submit claims to MetroPlusHealth medical benefit via the HCPCS codes listed below:
HCPCS Code | Value |
---|---|
99605* | Medication therapy management service(s) provided by a pharmacist, individual, face-to-face with patient, with assessment and intervention if provided: 15 minutes, new patient. |
99606* | Medication therapy management service(s) provided by a pharmacist, individual, face-to-face with patient, with assessment and intervention if provided: 15 minutes, established patient. |
All other MetroPlusHealth plan members: to find a participating pharmacist, locate and contact your local in-network pharmacy here.
If you have any questions regarding this memo, please contact MetroPlusHealth at: [email protected].