New over-the-counter birth control pill reimbursable by Apple Health (Medicaid)

Washington State Health Care Authority sent this bulletin at 04/02/2024 08:00 AM PDT

April 2, 2024

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New over-the-counter birth control pill reimbursable by Apple Health (Medicaid)

HCA reimburses certain over-the-counter (OTC) family planning supplies without a prescription, such as condoms, emergency contraception, spermicides, and now, a progestin-only birth control pill.

Norgestrel oral tablets (Opill) are used to prevent pregnancy—the first daily oral contraceptive approved for use in the U. S. without a prescription—received FDA approval July 13, 2023.

The new OTC pill is expected to be on store shelves at major retailers nationwide in the coming weeks. Any drugs reimbursable by Apple Health (Medicaid), including OTCs, will be on the Apple Health Preferred Drug List.

See the most recent list for a current list of covered drugs, including Opill.

Apple Health clients primarily access OTCs at the pharmacy counter

While OTC contraception does not require a prescription, it must be billed by a pharmacy to be eligible for reimbursement.

View the Health Care Authority's (HCA) client FAQ for more information on OTC contraceptives.

How do I bill OTC contraceptives as a pharmacist?

To bill OTC contraceptives, pharmacies must follow the National Council for Prescription Drug Programs (NCPDP) standard and use the national drug code (NDC) or universal product code (UPC) found on the package.

A prescription for OTC contraceptives is not required.

View the pharmacy OTC contraceptive FAQ for more details.

More information

For more information on the new FDA-approved progestin-only pill, visit:

About the Health Care Authority (HCA)

Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

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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