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Family planning waiver renewal changes

Family planning waiver renewal changes

Effective Jan. 1, 2015, Division of Medicaid’s Family Planning Waiver (FPW) was renewed by Centers for Medicare and Medicaid Services (CMS). The FPW renewal stipulates that coverage now includes males and females aged 13-44 with family income at or below 194 percent of the Federal Poverty Level and must not have had a procedure that prevents them from reproducing or be covered under Medicare, CHIP or other health insurance. Another change is that in addition to contraceptives, drugs to treat sexually transmitted infection (STI)*/sexually transmitted diseases (STD)*, when prescribed as part of a family planning visit/treatment by any Medicaid participating provider, are included.

Beneficiaries enrolled in the FPW have a yellow Medicaid card are only eligible for family planning and family planning related pharmacy services.

Beneficiaries in the FPW program can get the following medications at their local participating Medicaid pharmacy:

  • Contraceptives (drug classes below follow the DOM PDL)
    1. Contraceptive Patches
    2. Self-inserted contraceptive products (like NuvaRing)
    3. Oral contraceptive agents
    4. Injectable contraceptives (like Depo Provera)
  • STI/STD treatments
    1. Injectable antibiotics for STD only covered through medical claims and not through POS.
    2. Drugs listed in the chart below to treat STD are exempt from the PDL, i.e. non-preferred drugs below do not require a prior authorization for FPW beneficiaries.
  • View the FPW renewal changes memo and drug classes

Learn more on the Family Planning webpage.