Apple Health (Medicaid) covers over the counter (OTC) contraception, including most emergency contraception, with or without a prescription for members. OTC contraceptives must be billed by a pharmacy for members to receive at no cost.
What OTC contraceptives are covered?
- Only products included in CHPW’s pharmacy database are covered. For a list of covered OTC birth control products, see the Apple Health covered OTC contraceptive list.
Does this include emergency contraception (morning after pill)?
- Yes, emergency contraceptives are covered.
Do I need to give my patient a prescription for OTC contraception?
- No, a prescription is not required to receive OTC contraceptives and have it covered by a pharmacy.
Does the pharmacy need my NPI to submit a claim for OTC contraceptives?
- Pharmacies do not need a prescriber NPI to submit a claim for OTC contraceptives unless you have written a prescription. For pharmacy billing instructions, see the CHPW Pharmacy page for details.
Will I be notified when my patient receives an OTC contraceptive?
- No, pharmacies are not required to notify you.
Are there limitations on OTC contraceptives?
- No, there are no limits on age, quantity, or frequency.
Additional information:
For more information to help your patient find the birth control that’s right for them, visit the Department of Health birth control and emergency contraception page. For more information about OTC contraception coverage at CHPW, please visit our member prescription coverage page.
Contact:
For questions, contact CHPW customer service at 1-800-440-1561 (TTY Relay: Dial 711) or email [email protected].
