New York State Medicaid Managed Care Plans

Summary of How Plans are Handling Emergency Contraception for Members 17 years of age and older without a written order

  • Summary is also available in Portable Document Format (PDF)

As of 07/2016

PLAN PROCESS FOR CLAIMS WITHOUT A PERSCRIBER INFORMATION (e.g., prescription/fiscal order is not required)
Affinity Health Plan Submit claim with blank prescriber information or Submit claim using the Pharmacy NPI in place of the prescriber NPI
Amida Care Submit claim using the Pharmacy NPI in place of the prescriber NPI
Health Now, Inc/BCBS of Western NY Emergency Contraceptive NDC´s bypass a Prescriber NPI edit to allow the claim to pay
CDPHP Submit claim with blank prescriber information or Submit claim using the Pharmacy NPI in place of the prescriber NPI
Crystal Run Submit claim with blank prescriber information or Submit claim using the Pharmacy NPI in place of the prescriber NPI.
Emblem Health the pharmacy can either leave the Prescriber NPI field blank, input a dummy NPI, or use the pharmacy NPI and the claim will process.
Empire BCBS Health Plus Submit claim using the Pharmacy NPI in place of the prescriber NPI
Excellus Submit claim using the individual Pharmacists NPI in place of the prescriber NPI
Fidelis Care Fidelis Care does not cover family planning products. These products should be billed to Medicaid FFS. Pharmacy can leave prescriber information blank.
Healthfirst Submit claim using the Pharmacy NPI in place of the prescriber NPI
Independent Health Submit Dummy Prescriber ID "ZZ3282100" in the prescriber field
MetroPlus Health Plan Pharmacy can leave prescriber information blank
MVP Submit claim using the Pharmacy NPI in place of the prescriber NPI
Total Care Submit claim using the Pharmacy NPI in place of the prescriber NPI
United Health Care Submit claim using the Pharmacy NPI in place of the prescriber NPI
WellCare Health Plans, Inc Submit claim using the dispensing pharmacy´s NPI prescriber NPI field
VNSNY Choice Submit claim using the Pharmacy NPI in place of the prescriber NPI
Your Care Pharmacy submits the claim with a valid NPI. The pharmacy NPI is allowed if there is no prescriber/Rx involved.

This is intended to provide general information only. Specific information regarding Medicaid managed care plan´s coverage for emergency contraception can be found by contacting the plan or by visiting the plan´s web site. If there is a discrepancy between this information and the plan´s information or web site, the plan´s information or web site shall apply.