Eligible Medications: Self-administered oral contraceptive pills, patches, vaginal rings, or injectable hormonal contraceptives (includes administration of injectable).
Prescription Limitations:
Up to 12 months’ supply (refills) of contraceptives.
Patients must complete a NEW Patient Intake Form every 12 months before receiving a pharmacist-prescribed contraceptive.
If a patient has not had a clinical visit with a healthcare provider (other than a pharmacist) for reproductive or sexual health within the past three years, referral is required.
Age Restrictions:
Patients must be 18 years or older.
Patients under 18 require documentation of a prior prescription from a licensed healthcare provider.
Documentation Requirements:
Completion of Oregon Contraceptive Self-Screening Questionnaire BEFORE prescribing.
Pharmacists must document each prescription and
notify the patient’s primary care provider within five days of prescribing.
Maintain records of patient interactions for at least seven years per Oregon BOP regulations; comply with HIPAA regulations.
Training Requirements: Pharmacists must complete Oregon Board of Pharmacy-approved training and provide proof of certification within 15 days of completion. Training covers clinical guidelines, patient assessments, and Oregon-specific prescribing rules.
Reimbursement Details
Eligibility
Oregon Medicaid and commercial insurers cover pharmacist-prescribed contraception. Medicaid reimburses pharmacists for both the consultation
visit and the prescribed contraception.
Pharmacists must be enrolled Oregon Medicaid providers and patients must be actively enrolled in the Oregon Health Plan (OHP) at the time of service.
Oregon Medicaid is the payer of last resort, meaning
pharmacists must first bill any third-party insurance (including Medicare) before submitting claims to Medicaid.
Billing Codes
Office Visits & Consultation Services New
patient evaluation or Established patient evaluation
CPT 99202 – New patient (15-29 min) CPT 99203 – New patient (30-44 min)
CPT 99212 – Established patient (10-19 min)
CPT 99401 – Preventive medicine counseling (~15 min) (Use FP Modifier for family planning services)
