On March 27, the State Department of Secondary Education published the following emergency orders in the New York Register (March 27, 2024, Vol XLVI, Issue 13).
- Pharmacist Dispensing Self-Administered Hormonal Contraceptives which was effective March 12, 2024, and
- Administration of Injectable Medications by Pharmacists for the Treatment of Mental Health and Substance Use Disorder, effective April 1, 2024.
Also in New York, the State Department of Health also issued a billing guidance on issuance of hormonal contraceptives. For NYRx billing, see below:
- To bill for the self-administered hormonal contraception, the pharmacy must submit a valid National Drug Code (NDC). Pharmacies must bill the Usual and Customary (U&C) price and will be reimbursed according to NYRx payment methodology and a $10.18 dispensing fee.
- To bill for the evaluation and management associated with the ordering of self- administered hormonal contraception, pharmacies will submit using the National Council for Prescription Drug Programs (NCPDP) D.0 claim format and enter one of the Healthcare Common Procedure Coding System (HCPCS) codes identified below.
- NYRx members may receive up to 12 months of prescription contraceptives at one time for family planning purposes as authorized by the Title 18 NYCRR Section 505.3(e).
- Pharmacies are expected to dispense up to the quantity limit of the prescription or Standing Order, one year supply, at the time of dispensing, pursuant to patient preference or primary insurance coverage limitations.
- Submitting any assessment code more than once a year requires cause.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.