Medicaid to Cover Condoms and Spermicides Over-the Counter

This bulletin applies to both NC Medicaid Direct and NC Medicaid Managed Care.

Effective Sept. 1, 2024, NC Medicaid will begin covering condoms and spermicides as over-the-counter products, through the pharmacy benefit.

Coverage supports reproductive health care for NC Medicaid beneficiaries, including prevention of unintended pregnancy and sexually transmitted diseases. Medicaid beneficiaries will be able to obtain condoms and spermicides from pharmacies enrolled in Medicaid with a prescription from a Medicaid-enrolled provider, with no cost sharing responsibility.

Pharmacy Providers

For condoms and spermicides to be covered by NC Medicaid, pharmacy providers should, upon receipt of a prescription:

• Ensure product dispensed is included in coverage, per the table below
• Process all claims as a point-of-sale prescription
• No copay should be collected

Claims will be paid based on the fee schedule below. A dispensing fee will not be paid to the pharmacy for dispensing of condoms and/or spermicide. Beneficiaries are allowed to obtain up to 30 condoms and spermicide films (76.5grams of gel) per month, with a prescription, with 11 refills. The annual limit is 360. No age limits apply.

Covered products and the reimbursement rate are listed below, effective Sept. 1, 2024.

Contact

NCTracks Call Center: 800-688-6696

For information on NC Medicaid Managed Care Health Plan effective dates, please contact health plans leveraging the information on the Health Plan Contacts and Resources page.