Montana pharmacists may prescribe certain drugs or devices (self-administered hormonal contraceptives) under limited circumstances, provided they:
Establish a patient-prescriber relationship through documented evaluation. Prescribe for conditions that DO NOT require a new diagnosis, or are minor/self-limiting, or can be diagnosed using a CLIA-waived test.
Are educationally prepared and competent in the area of prescribing.
Standing Order
Not required in Idaho. Idaho Pharmacists may independently prescribe under the conditions specified above.
Eligible Medications: Contraceptive pills, patches, and vaginal rings, and depot injections.
Prescription Limitations: Up to 12 months’ supply (refills) of contraceptives.
Age Restrictions: No specific age requirement, but pharmacists must screen patients using USMEC guidelines.
Documentation Requirements: Pharmacists must maintain documentation that justifies the care provided, including:
Patient record information
Prescription records
Notifications to other providers
Follow-up care plans
They must also recognize the limits of their knowledge and refer patients to other healthcare
providers when appropriate.
Training Requirements: Pharmacists must complete a Board-approved contraceptive prescribing training program before providing services. Establishing a patient/provider relationship, demonstrating competency through education and training, and maintaining documentation to justify the care provided. *This documentation must be available for inspections.
Reimbursement Details
Eligibility
Pharmacists must enroll as individual providers or as rendering providers under a clinic or facility via Montana Provider Service Portal.- Must submit
NPI and NABP/NCPDP numbers (Must submit 365 days from date of service to receive reimbursement.) Use rendering-only provider application if not billing as a standalone entity.
Billing Codes
CPT/HCPCS: 99201–99215, S4993 (if payer accepts); J1050 for Depo-Provera.
Diagnosis: Z30.011 (initial contraceptive prescription). Include the 11-digit NDC, origin code, days supply, provider NPI, and NABP number.
Submission Process
*New system for processing and paying Montana healthcare claims. The claims project kicked off in October 2024, with plans to roll out the new system in 2027. Please visit Claims Modernization on the DPHHS website.
