Pharmacists cannot independently prescribe hormonal contraceptives in South Carolina.
Standing Order
They may dispense and administer contraceptives under a standing order from a licensed prescriber, as outlined in the South Carolina Pharmacy Access Act.
Collaborative Practice Agreements (CPA)
Pharmacists cannot prescribe hormonal contraceptives through CPAs.
Eligible Medications: Contraceptive pills, patches, and vaginal rings, and depot injections.
Prescription Limitations:
Refills: Up to 12 months per prescription.
Follow-Up Requirement: Patients must provide evidence of a clinical visit with a healthcare
provider if 24 months have passed since their initial hormonal contraception prescription from a pharmacist.
Age Restrictions:
Available for patients 18 years and older without a prior prescription.
Minors under 18 require prior prescription from a healthcare provider.
Documentation Requirements: A pharmacy patient record must be maintained for a period of not less than two years from the date of the last entry in the profile record. This record may be a hard copy or a computerized form.
Training Requirements: Pharmacists must complete a certificate program accredited by the American Council for Pharmacy Education (ACPE) or an equivalent body.
Must complete at least one hour of continuing education related to hormonal contraceptives annually.
Reimbursement Details
Eligibility
Pharmacist must be enrolled as an ordering, referring, and prescribing provider under the Medicaid program prior to rendering a pharmacist service that is submitted by a Medicaid pharmacy provider for reimbursement pursuant to this section.
Billing Codes
Reimbursement rates are set at 80% of physician rates.
New Patient Visit (20 min) 99202
New Patient Visit (30-44 min) 99203
Established Patient Visit (<10 min) 99211
Established Patient Visit (10-19 min) 99212
Established Patient Visit (20-29 min) 99213
Established Patient Visit (30-39 min) 99214
Injection Administration 96372
Urine Pregnancy Test 81025
Submission Process
Medicaid Provider Enrollment: Pharmacists must enroll as an "individual pharmacist" under the provider type “other medical professional” via Healthy Connections Medicaid.
Claims must be submitted using the CMS-1500 form under Medicaid’s medical benefit.
Covered services, training guide and billing guidance are available in the Physician Services
Provider Manual on the SCDHHS website.
Applies to full-benefit Medicaid members and Family Planning limited benefit program enrollees.
