- Refer to the Mosquito Repellent Standing Order Prescription Template (HHS Form 1404) for claims filled using the Texas Medicaid Standing Order for Mosquito Repellent.
- Pharmacies should process the claim per the prescription details if a written prescription is provided.
Claims for mosquito repellent must use the appropriate prescriber National Provider Identifier (NPI) as directed in the pharmacy claims submission table, below.
|Client's Healthcare Provider||✓||✓||✓||✓|
|Dr. Van Ramshorst||✓||✓||✓|
- Each product’s 12-digit Universal Product Code (UPC) has been converted into an 11-digit National Drug Code (NDC) for claims submission.
- Mosquito repellent will be treated as a generic medication and pharmacies have the authority to fill the prescription with any covered product, unless the prescriber has stated "do not substitute" to specify the active ingredient.
Pharmacy staff submit the standard unit in the “Unit of Measure” field (60028) when processing claims.
For example, a 170-gram bottle should be submitted with a quantity of 170.
A can of repellent is expected to last 15 days or more. Pharmacy staff are recommended to submit a 15-day supply.
- The traditional Medicaid reimbursement is the usual and customary price to the public or up to a maximum of $6.50 per can/bottle of mosquito repellent (inclusive of product cost and dispensing fee), with the total calendar month maximum of $13.00. Products are not eligible for delivery fees or incentive fees.
- Reimbursement may vary between MCOs but may not exceed $6.50 per can/bottle.
- Pharmacies will be required to submit their usual and customary cost for the items.
Manual overrides for pregnant women 9 or younger or 55 or older may be needed.
- For traditional Medicaid and HTW, contact the Pharmacy Benefits Access Help Desk at 1-800-435-4165.
- For Medicaid managed care or CHIP, refer to the Prescriber MCO Assistance Chart (PDF).