MedicaidCoverageMedium impact
MAB2024041001
Pennsylvania Medicaid (DHS)·PA · Family Medicine, OB-GYN, Internal Medicine +2 more·Provider Bulletin
Effective date
Apr 10, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now covers FDA-approved over-the-counter oral contraceptives (like Opill) when prescribed by enrolled practitioners. These OTC contraceptives will be added to the Statewide Preferred Drug List and follow the same prior authorization guidelines as prescription oral contraceptives.
Action Required
Immediately: Billing team should verify that OTC oral contraceptives like Opill can be billed for Pennsylvania Medicaid patients when prescribed by enrolled practitioners. Check the updated Statewide PDL for preferred/non-preferred status and ensure prior authorization processes follow existing oral contraceptive guidelines per MA Bulletin 01-22-24. Update staff to ensure prescriptions are required even for OTC contraceptives.