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3.3.6.1 Prescriptions and Dispensing Medication
Family planning agencies may do one or both of the following:
• Dispense family planning drugs and supplies directly to the client and bill TMHP.
•Write a prescription for the client to take to a pharmacy.
Family planning drugs and supplies that are dispensed directly to the client must be billed to TMHP or to the client's Medicaid managed care organization (MCO). Only family planning agencies may be reimbursed for dispensing family planning drugs and supplies. Family planning agencies may be reimbursed for dispensing up to a one year supply of contraceptives in a 12-month period using procedure code J7303, J7304, or S4993. The appropriate family planning diagnosis code must be included on the claim.
Title XIX clients may have prescriptions filled at the clinic pharmacy or at another pharmacy. Pharmacies under the Vendor Drug Program are allowed to fill all prescriptions as prescribed. Family planning drugs and supplies are exempt from the three prescriptions-per-month rule for up to a six-month supply.
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