11. Mosquito Repellent

1. Mosquito Repellent Benefit

Texas HHS covers mosquito repellents for the prevention of the Zika virus. HHS initially offered the benefit between Aug. and Dec. 2016 and again between April and Dec. 2017.  Mosquito repellents became a year-round benefit as of Feb. 2018.

1.1 Eligible Populations

The eligible populations for the mosquito repellent benefit include:

  • Females ages 10-55 years old and pregnant females of any age 
  • Males ages 14 and older

1.2 Quantity 

Coverage of mosquito repellents is limited to two cans or bottles per calendar month.  Pharmacies should dispense only one can or bottle per fill, with one optional refill available per calendar month.

Mosquito repellent claims do not count against a person’s monthly three-prescription limit for people enrolled in traditional Medicaid.

1.3 Client Responsibility

Approved claims for people eligible for Medicaid, HTW program, and CSHCN Services Program are provided at no cost.

People enrolled in CHIP may be subject to a copay depending upon family income. Any potential copays should not exceed the cost of the product.

1.4 Covered Products

Texas HHS selected products based on guidance from the Centers for Disease Control and include the recommended amount of the active ingredient DEET, IR3535, oil of lemon eucalyptus, or Picaridin effective against the Zika virus.

NDC Product Name Product UPC Package Size Unit of Measure Active Ingredient
11423000338 Repel Sportsmen Max 40% spray 011423003387 184 GM DEET
11423094109 Repel Lemon Eucalyptus 30% spray 011423941092 118 ML Oil of Lemon Eucalyptus
11423094133 Repel Sportsmen Dry 25% spray 011423941337 113 GM DEET
11423094137 Repel Sportsmen 25% spray 011423941375 184 GM DEET
11423094139 Repel Hunter's 25% spray 011423941399 184 GM DEET
46500071764 Off Deep Woods Dry 25% spray 046500717642 113 GM DEET
46500001842 Off Deep Woods 25% spray 046500018428 170 GM DEET
46500001859 Off Deep Woods 25% spray 04650001859X 311 GM DEET
46500021845 Off Deep Woods 25% spray 046500218453 177 ML DEET
46500022930 Off Deep Woods 25% spray 04650022930X 255 GM DEET
46500061851 Off Deep Woods Sportsmen 30% spray 046500618512 170 GM DEET
46500072131 Off Deep Woods Dry 25% spray 04650072131X 113 GM DEET
46500072925 Off Deep Woods 25% spray 046500729256 266 ML DEET
46500081846 Off Deep Woods Sportsmen 25% spray 046500818462 177 ML DEET
51131067777 Ultrathon 25% repellent spray 051131677777 170 GM DEET
68093000746 Coleman SkinSmart 368093007468 147 ML IR3535
68093000747 Coleman SkinSmart 368093007473 170 GM IR3535
68093007514 Coleman High-Dry 25% spray 368093075146 113 GM DEET
68093007732 Coleman Botanicals insect spray 368093077324 118 ML Oil of Lemon Eucalyptus
71121096014 Cutter Lemon Eucalyptus spray 071121960146 118 ML Oil of Lemon Eucalyptus
71121096280 Cutter Backwoods 25% spray 071121962805 170 GM DEET
71121096283 Cutter Backwoods 25% spray 071121962836 311 GM DEET
71121096284 Cutter Backwoods 25% spray 071121962843 177 ML DEET
71121096435 Cutter Backwoods Dry 25% spray 071121964359 113 GM DEET
44224006878 Natrapel 20% spray 044224068781 177 ML Picaridin
50716000544 Insect Repellent 20% spray (Sawyer) 050716005448 118 ML Picaridin

1.5 Refills

Pharmacies should process refills per the prescription detail if operating under written prescription or the Texas Medicaid Standing Order for Mosquito Repellent. If you operate under the standing order, contacting or faxing the physician listed on the standing order is unnecessary for refill requests or fax refill requests.

1.6 Other Medicaid Benefits 

Other Medicaid benefits available in response to Zika virus prevention include oral contraceptives and long-acting reversible contraceptive products that help to prevent pregnancy. These are available as a Medicaid benefit to eligible individuals. Other covered benefits include family planning services, diagnostic testing, targeted case management, physical therapy, long-term services and support, acetaminophen and oral electrolytes for Zika virus symptoms, and potential coverage for additional ultrasounds for pregnant women.

2. Covered Programs

The mosquito repellent benefit is available for people enrolled in the following programs:

  • Medicaid (traditional and managed care)
  • Children's Health Insurance Program and CHIP-Perinatal
  • Healthy Texas Women program (HTW)
  • Children with Special Health Care Needs services program

2.1 Medicaid, CHIP and HTW

HHSC issued the Texas Medicaid Standing Order for Mosquito Repellent for use by people enrolled in Medicaid, CHIP and HTW. This order serves as a prescription and allows pharmacists to dispense mosquito repellent under the terms of the order. Pharmacies are encouraged to use this order instead of contacting the person’s healthcare providers for individual prescriptions for mosquito repellent. A prescription from a valid healthcare provider is required for any pharmacy or pharmacist not operating under the standing order.

Pharmacy staff request a copy of the standing order by emailing vdp-formulary@hhsc.state.tx.us.

The Mosquito Repellent Standing Order Prescription Template (HHS Form 1404) is available on the VDP website. The template is used only in the processing of claims for mosquito repellent for people enrolled in Texas Medicaid, CHIP and HTW under the standing order for mosquito repellent. Any unauthorized use of the prescriber information within the template is referred to the HHS Inspector General as potential fraud.

2.2 CSHCN Services program

A prescription is required for people enrolled in the CSHCN services program. Contact the person’s health care provider to obtain a prescription for mosquito repellent.

3. Pharmacy Claim Submission

3.1 Prescriptions

Pharmacy Claims

Claims for mosquito repellent must use the appropriate prescriber National Provider Identifier (NPI) as directed in the pharmacy claims submission table, below.

Prescriber NPI Medicaid CHIP CSHCN HTW
Client's Healthcare Provider
Dr. Van Ramshorst  

3.2 Products

  • 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.

3.3 Unit of Measure 

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. 

3.4 Days Supply 

A can of repellent is expected to last 15 days or more. Pharmacy staff are recommended to submit a 15-day supply.

3.5 Reimbursement

  • 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. 

3.6 Overrides

Manual overrides for pregnant women 9 or younger or 55 or older may be needed.

Appendix A. Mosquito Repellent Products

Covered products have been selected based on guidance from the Centers for Disease Control and include the recommended amount of the active ingredient DEET, IR3535, oil of lemon eucalyptus, or Picaridin.

NDC Product Name Product UPC Package Size Unit of Measure Active Ingredient
11423000338 Repel Sportsmen Max 40% spray 011423003387 184 GM DEET
11423094109 Repel Lemon Eucalyptus 30% spray 011423941092 118 ML Oil of Lemon Eucalyptus
11423094133 Repel Sportsmen Dry 25% spray 011423941337 113 GM DEET
11423094137 Repel Sportsmen 25% spray 011423941375 184 GM DEET
11423094139 Repel Hunter's 25% spray 011423941399 184 GM DEET
46500071764 Off Deep Woods Dry 25% spray 046500717642 113 GM DEET
46500001842 Off Deep Woods 25% spray 046500018428 170 GM DEET
46500001859 Off Deep Woods 25% spray 04650001859X 311 GM DEET
46500021845 Off Deep Woods 25% spray 046500218453 177 ML DEET
46500022930 Off Deep Woods 25% spray 04650022930X 255 GM DEET
46500061851 Off Deep Woods Sportsmen 30% spray 046500618512 170 GM DEET
46500072131 Off Deep Woods Dry 25% spray 04650072131X 113 GM DEET
46500072925 Off Deep Woods 25% spray 046500729256 266 ML DEET
46500081846 Off Deep Woods Sportsmen 25% spray 046500818462 177 ML DEET
51131067777 Ultrathon 25% repellent spray 051131677777 170 GM DEET
68093000746 Coleman SkinSmart 368093007468 147 ML IR3535
68093000747 Coleman SkinSmart 368093007473 170 GM IR3535
68093007514 Coleman High-Dry 25% spray 368093075146 113 GM DEET
68093007732 Coleman Botanicals insect spray 368093077324 118 ML Oil of Lemon Eucalyptus
71121096014 Cutter Lemon Eucalyptus spray 071121960146 118 ML Oil of Lemon Eucalyptus
71121096280 Cutter Backwoods 25% spray 071121962805 170 GM DEET
71121096283 Cutter Backwoods 25% spray 071121962836 311 GM DEET
71121096284 Cutter Backwoods 25% spray 071121962843 177 ML DEET
71121096435 Cutter Backwoods Dry 25% spray 071121964359 113 GM DEET
44224006878 Natrapel 20% spray 044224068781 177 ML Picaridin
50716000544 Insect Repellent 20% spray (Sawyer) 050716005448 118 ML Picaridin