Traditional Medicaid

Certain family planning drugs do not count towards a client's three prescription-per-month limitation. Refer to the Formulary search and select the "Family Planning" filter to identify these drugs, which include:

• Oral contraceptives
• Long-acting injectable contraceptives
• Vaginal rings
• Hormone patches
• Certain drugs used to treat sexually transmitted diseases (STDs)

In compliance with Texas Insurance Code, Section 1369.1031, Medicaid provides up to a three-month supply of covered prescription contraceptive drugs the first time a client obtains the drug, then a 12-month supply at one time each subsequent time the client obtains the same drug. This does not apply to contraceptives under the clinician-administered drug benefit.

VDP defines the "same drug" as a drug that can be therapeutically substituted (for example, multiple formulations, strengths, and NDCs).

CSHCN Services Program

The prescribing physician must compose a letter of medical necessity (LMN) on office stationery. Pharmacy providers must submit the LMN by fax to the CSHCN Service Program.

CHIP

CHIP covers birth control for certain diagnoses. Contraceptives are only covered for non-contraceptive medical purposes. Pharmacy providers should contact the client's MCO for details.