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December 2016 Texas Medicaid Provider Procedures Manual

Women’s Health Services Handbook : 3 Health and Human Services Commission (HHSC) Family Planning Program Services : 3.2 Services, Benefits, Limitations, and Prior Authorization : 3.2.7 Drugs and Supplies : 3.2.7.1 Prescriptions and Dispensing Medication

3.2.7.1
Providers may do one or both of the following:
Family planning drugs and supplies that are dispensed directly to the client must be billed to HTW. Only providers with an appropriate pharmacy license may be reimbursed for dispensing family planning drugs and supplies. Provider types with an appropriate pharmacy license 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.
HHSC Family Planning Program clients may have their prescriptions filled at the clinic pharmacy. HHSC Family Planning Providers can refer to the HHSC Family Planning Policy and Procedure Manual for additional guidance on dispensing medication.
Note:
Pharmacies under the Medicaid 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 Medicaid Vendor Drug Program.

Texas Medicaid & Healthcare Partnership
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