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2012 Texas Medicaid Provider Procedures Manual

Gynecological and Reproductive Health and Family Planning Services Handbook : 3. Women’s Health Program (Title XIX Family Planning) : 3.3 Services, Benefits, Limitations, and Prior Authorization : 3.3.6 Drugs and Supplies : 3.3.6.1 Prescriptions and Dispensing Medication

3.3.6.1
Family planning agencies may do one or both of the following:
Family planning drugs and supplies that are dispensed directly to the client must be billed to TMHP. 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.
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.
Refer to:
Appendix B: Vendor Drug Program (Vol. 1, General Information) for information about outpatient prescription drugs and the Vendor Drug Program.

Texas Medicaid & Healthcare Partnership
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