5101:3-9-14 Pharmacy services: limited family planning benefit.

(A) Definitions

(1) "Family planning services" and "pregnancy prevention/contraceptive management services" are defined in rule 5101:3-21-02 of the Administrative Code.

(2) "Family planning-related services" are defined in rule 5101:3-21-02.3 of the Administrative Code.

(B) Individuals who meet the eligibility criteria in rule 5101:1-41-40 of the Administrative Code have a limited medicaid benefit as described in rule 5101:3-21-02.3 of the Administrative Code. Pharmacy services are limited to the following:

(1) Pregnancy prevention/contraceptive management

(a) Drugs listed in appendix A to rule 5101:3-9-12 of the Administrative Code that are included in the following drug classes:

(i) G8A - Contraceptives, oral; and

(ii) G8F - Contraceptive, transdermal; and

(iii) G9B - Contraceptives, intravaginal, systemic; and

(b) Contraceptive supplies listed in appendix A to rule 5101:3-9-02 of the Administrative Code.

(2) Family planning-related drugs used to treat sexually transmitted infections (STIs) other than human immunodeficiency virus (HIV) and hepatitis that are listed in the appendix to this rule. These drugs are included in the recommended treatment regimens published by the federal centers for disease control and prevention.

(a) The appendix to this rule includes three columns to indicate drug coverage:

(i) Drug class. This column describes the therapeutic class of drug.

(ii) Drug name. This column names each drug covered for treatment of STIs under the limited family planning benefit.

(iii) Co-payment. This column indicates the medicaid co-payment that applies to each drug in accordance with rule 5101:3-9-09 of the Administrative Code."2" indicates that a two dollar co-payment applies, "0" indicates that zero co-payment applies.

(b) The prescriber must include family planning diagnosis in the V25 series on all prescriptions issued for consumers enrolled in the limited family planning benefit for drugs used for the treatment of STIs.

(c) The pharmacy claim must include the family planning diagnosis indicated on the prescription.

(C) The provisions of rules 5101:3-9-01 to 5101:3-9-06 and 5101:3-9-09 of the Administrative Code apply to claims billed under the limited family planning benefit.

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Effective: 01/01/2012
R.C. 119.032 review dates: 01/01/2017
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.0112 , 5111.02 , 5111.021