Albertsons Companies to Bill Medicaid for Contraceptive Consultation Service Fee in Oregon

As part of a collaborative effort to improve access to hormonal contraception for Oregon women, Albertsons Companies announced that select pharmacies can now bill Oregon Medicaid plans for the consultation service fee and was the first in the nation to successfully complete the process for a patient.

Following the implementation of Oregon bill HB 2879, which allowed anyone 18 years and older to receive birth control prescribed by a pharmacist, Albertsons Companies, in partnership with Oregon State University, worked to develop the processes that now allow Oregon pharmacists to be paid by Medicaid for the consultation service fee when prescribing birth control, eliminating the fee for the Medicaid patient.

"Oregon was the first in the nation to implement a law that gave women access to hormonal contraceptives through their local pharmacy," saya Mark Panzer, senior vice president, Albertsons Companies, Pharmacy Health and Wellness. "We are excited to be at the forefront with them to broaden patient access to healthcare services, decrease financial barriers, and add to ways that community pharmacists can directly and conveniently provide care for customers through the pharmacy."

While the effort to set up billing through Medicaid for Oregon women is a milestone, the work is not complete.

"We are strategically expanding the service with Oregon insurance providers and pharmacy retailers to extend this billing capability for hormonal contraceptives," says Paige Clark, RPh, director of alumni relations and professional development, Oregon State University/OHSU College of Pharmacy. "Eventually, we anticipate all insurance plans will have processes in place to cover the pharmacist consultation service fee so that any woman in Oregon who wants birth control can have access to it, regardless of their financial constraints."

The process for obtaining hormonal contraceptives through a pharmacist is simple. No appointment is needed. The patient completes a self-assessment questionnaire and meets with the pharmacist in a private area to discuss their information and personal contraceptive needs. If the patient's self-assessment information and blood pressure are acceptable, the pharmacist creates the written prescription, counsels the patient and dispenses the medication in pill, patch, ring or depo form depending on state law. The process takes about 15 minutes.

The process for billing consists of two transactions: one for the medication and another for the consultation service fee. Insurance already covers the cost of birth control medication. The pharmacist consultation service fee, which is now covered by Medicaid, is reimbursed at the same rate as Medical Doctors, Doctors of Osteopathy, Nurse Practitioners, and Physician Assistants. If a patient does not have insurance, she has the option to pay cash for the consultation service and can discuss with the pharmacist what low-cost contraceptive choices are available to her.

Limitations to women obtaining hormonal birth control directly from a pharmacist may include high blood pressure, certain health conditions, and contraindications to the hormonal contraceptive therapy.