Apple Health covers OTC emergency contraceptive pills without a prescription

Washington State Health Care Authority sent this bulletin at 10/25/2021 02:26 PM PDT

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Apple Health covers OTC emergency contraceptive pills without a prescription

The Health Care Authority was recently informed of a patient issue where an Apple Health (Medicaid) client was denied OTC emergency contraceptive pills as an Apple Health benefit. Pharmacy staff advised the client that her options were to get a prescription from an urgent care or to pay out of pocket.

What is covered

As a reminder, Apple Health (Medicaid) covers OTC emergency contraceptive pills without a prescription. With a prescription, non-OTC emergency contraceptive pills are also covered.

Please take this opportunity to review the HCA Prescription Drug Program Billing Guide; the content on emergency contraceptive pills starts on page 40. While this message focuses on emergency contraception, there are other medications available to Apple Health clients from pharmacies without a prescription or under standing orders.

Questions

For additional questions on billing, please contact the Medical Assistance Customer Service Center (MACSC) at 1-800-562-3022.

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.