Payment of LARCs through the Pharmacy Benefit

 

Beginning with dates of service on or after March 17, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will reimburse for outpatient utilization of long acting reversible contraceptives (LARC) through the pharmacy program. Any LARC billed to SCDHHS by a pharmacy will be shipped directly to the provider's office for insertion. Providers should take extra care to ensure that they bill Medicaid only for reimbursement of the insertion of the device, and not the device itself, when it is obtained and billed through the pharmacy benefit.

While the option will exist to bill LARCs through the pharmacy benefit, providers may continue to purchase these devices and bill them via the traditional "buy and bill" mechanism.

Specific products affected by this update include: Mirena®, ParaGard®, Skyla®, Implanon® and Nexplanon®.

This policy applies to services provided to beneficiaries who are enrolled in fee-for-service Medicaid, however the Managed Care Organizations operating in the State are aware of this new option and should be contacted directly for information on their coverage. If you have any questions regarding this policy, please contact the Provider Service Center at (888) 289-0709. Thank you for your continued support of the South Carolina Healthy Connections Medicaid Program.

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