Troubleshooting persistent side effects

Name: Troubleshooting persistent side effects
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Prescriptive Authority Options

Prescription Authority:

Enables independent prescribing of contraceptives by pharmacists under state guidelines.

Helpful Links: Utah Code § 58-17b-803 & Administrative Rule R156-17b.

Pro's: Easiest to implement, no state forms required, simply follow standard of practice for prescribing.

Con's: regulations are weak

Standing Order:

Allows pharmacists to prescribe contraceptives following patient assessment protocols.

Helpful Codes: Utah Code § 26B-4-505 & R433-200.

Collaborative Practice Agreements:

Allows prescribing under agreements with supervising healthcare providers.

Helpful Links: (CPA), Utah Code § 58-17b-102 & R156-17b-614.

Link text

Quick Anatomy Definitions

Why This Matters:

Persistent side effects from hormonal contraception are one of the most common reasons patients discontinue or switch methods. Pharmacists are uniquely positioned to recognize patterns, validate patient concerns, and recommend evidence-based alternatives—or refer when needed.

If a side effect persists beyond 2–3 months and significantly impacts quality of life, switching to a different formulation or method may improve tolerability and adherence.

Side Effect Management Table

Symptom	Methods More Likely to Cause	Consider Switching To
Acne	Progestin-only pills (POPs), DMPA	COCs or vaginal ring (if no estrogen contraindications)
Amenorrhea	DMPA, continuous COCs or vaginal ring	Cyclic COC regimens or POP (if regular bleeding desired)
Breakthrough Bleeding	Low-dose COCs, POPs, continuous regimens	COC with up to 35 mcg EE, patch, or ring with ≥3-day hormone-free interval
Breast Tenderness	Patch	COC with ≤20 mcg EE or vaginal ring
Decreased Libido	Very low-dose COCs (15 mcg EE)	COC with higher EE dose (up to 35 mcg)
Depressed Mood	DMPA (possible link)	Try COC, patch, or vaginal ring; refer if symptoms persist
Headache	All hormonal methods (esp. >35 years old)	No method shown superior; screen for migraines with aura—estrogen contraindicated in these cases
Heavy Menses	DMPA	COCs, patch, or vaginal ring
Hirsutism	POPs, DMPA	COCs (especially with anti-androgenic progestins)
Increased Vaginal Discharge	Vaginal ring	COC, patch, or POP
Irregular Menses	DMPA, emergency contraception	COC, patch, ring, or POP
Nausea	Patch, emergency contraception	Vaginal ring; antiemetics if EC is needed
Oily Skin	POPs, DMPA	COCs
Weight Gain	DMPA	COCs, patch, ring, or POP

Key Counseling Points

Normalize some side effects during the first 1–3 months, but empower the patient to track them.
Explain expected changes when switching methods—especially in bleeding patterns, mood, and skin/hair.
Use patient-centered language ("How is this affecting your daily life?" vs. "That’s a common side effect.")
Consider adherence and lifestyle—a side effect that compromises consistency may be more harmful than the symptom itself.

Note: This resource is intended for pharmacists and healthcare professionals. Always refer to the latest clinical guidelines and product labeling for prescribing decisions.

State Requirements

Eligible Medications: Contraceptive pills, patches, and vaginal rings.

Prescription Limitations: Up to 12 months of refills. Follow-up required after two years.

Age Restrictions: Patients must be 18 years or older.

Documentation Requirements: Maintain patient records for 7 years; comply with HIPAA regulations.

Training Requirements: Completion of state-mandated courses for prescribing and patient counseling.

Reimbursement Details

Eligibility:

Medicaid Enrollment - Confirm Medicaid Eligibility for covered contraceptive services.
Pharmacists must be licensed in Utah and enrolled as a provider with Utah Medicaid to receive reimbursement.
Pharmacists dispensing self-administered hormonal contraceptives under a standing order are eligible for an annual consultation fee reimbursement of up to $20.

Billing Codes:

Use CPT Code 99401 (preventive counseling) with FP Modifier for family planning services. Pharmacy claims for self-administered hormonal
contraceptives must include one of the following diagnosis codes:

Z30.011 – Encounter for
initial prescription of contraceptive pills
Z30.015 – Encounter for
initial prescription of vaginal ring hormonal contraceptive
Z30.016 – Encounter for
initial prescription of transdermal patch hormonal contraceptive

Dispensing Fee:

Pharmacists can receive a dispensing fee for prescriptions billed under Medicaid when using their Medicaid-registered individual NPI.

Submission Process:

Submit claims via Utah Medicaid PRISM system.

Electronic Submission: All claims must be submitted electronically using the National Council for Prescription Drug Plan (NCPDP) Version D.0 standard.
Claims are processed in real time through the point-of-sale (POS) system.
NPI Requirement: Claims must include the prescriber’s valid National Provider Identifier (NPI). Claims with incorrect or missing NPIs will be denied or subject to recoupment.