Long-acting Reversible Contraception Products

Pharmacy Benefit

Providers can prescribe and obtain LARC products that are on the Texas Medicaid and Healthy Texas Women (HTW) Program formularies from certain specialty pharmacies for women participating in those programs.  LARC products are only available through a limited number of specialty pharmacies that work with LARC manufacturers.  Providers who prescribe and obtain LARC products through these specialty pharmacies will be able to return unused and unopened LARC products to the manufacturer's third-party processor.

Please review the LARC FAQ (PDF) for detailed information regarding prescribing, pharmacy participation, obtaining LARC products, Medicaid managed care participation, and the LARC buy-back program.

The following products are currently available:

Providers may also continue to obtain LARC products through the existing buy-and-bill process.

Manufacturer Resources

Bayer

• Specialty Pharmacy Prescription Request Form (PDF)
• Abandoned Unit Program FAQ/Return Form (PDF)

Merck

• Abandoned Unit FAQ (PDF)
• Abandoned Unit Form (PDF)

Teva

• Patient Authorization Form
  Patient Referral Form
• Abandoned Unit Process (PDF)