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ZIKA: Notice to Prescribers | Mosquito Repellent Benefit

Texas Health and Human ServicesApril 24, 2017Articles

Texas covers select mosquito repellents for the prevention of Zika virus. The following
notice describes how clients may access mosquito repellent through Medicaid and other state programs, and provides essential information for prescribers regarding the mosquito repellent benefit.
Covered programs:

  • Medicaid (managed care, MCO; and fee-for-service, FFS)
  • Children’s Health Insurance Program (CHIP) and CHIP-Perinatal
  • Healthy Texas Women
  • Children with Special Health Care Needs Services Program (CSHCN)
  • Family Planning Program

Medicaid (FFS and MCO) and CHIP Clients
The Texas Medicaid Medical Director has issued a Texas Medicaid Standing Order for Mosquito Repellent for use by pharmacies. Eligible clients that use pharmacies that dispense mosquito repellent under this Standing Order will not require a prescription from their healthcare provider. The Texas Medicaid Standing Order for Mosquito Repellent is available for Texas Medicaid (FFS and MCO) and CHIP clients, at a participating Medicaid-enrolled pharmacy.

HTW Clients
Eligible women in the HTW program may obtain mosquito repellent from a participating Medicaid-enrolled pharmacy, without a prescription.

CSHCN Clients
Clients in the CSHCN program require a prescription from their health care provider for the dispensing of mosquito repellent from a participating Medicaid-enrolled pharmacy.

Family Planning Program Clients
Clients in the Family Planning program may pick up mosquito repellent at a participating Family Planning Program clinic. Prescribers with questions may contact the Family Planning Program at FamPlan@hhsc.state.tx.us.

Benefit Details

Eligible Clients:

  • Females ages 10-55 years and pregnant women of any age
  • Males ages 14 years and older

Benefit Limits:

  • One (1) can/bottle of mosquito repellent per prescription fill, with one (1) additional refill allowed per client, per calendar month May 1, 2017 through December 31, 2017

How to Prescribe Mosquito Repellent
For CSHCN clients, and clients unable to access a pharmacy operating under a standing order for the dispensing of mosquito repellent, prescribers are recommended to include the following details when prescribing mosquito repellent to help minimize requests for clarification from pharmacies or requests for refills for mosquito repellent.

Recommended prescription details
Drug Name: “Mosquito repellent”

  • Mosquito repellent will be treated as a generic medication and pharmacies will have
    the authority to fill the prescription with any covered product.
  • Please specify the active ingredient if your patient cannot tolerate one and note “Do not substitute.”

Directions: Use topically, as directed.
Quantity: One (1) can/bottle
Refills: 11

  • It is recommended that prescribers send prescriptions to pharmacies via phone, fax, or electronic prescription to minimize office visits.
  • Prescribers should not schedule office visits solely for clients to obtain a mosquito repellent prescription, unless medically necessary.
  • Prescribers should consider offering mosquito repellent prescriptions to eligible clients at any pre scheduled office visits to minimize follow up requests for mosquito repellents.
  • Clients in the HTW program do not require a standing order or prescription. Pharmacies have been provided with claims submission instructions for the HTW program.
  • Recommendations for children: mosquito repellent should not be used in infants less than two months of age. A mosquito repellent containing oil of lemon eucalyptus should not be used for a child less than three years of age. Concentrations of mosquito repellent are recommended to contain no more than 30 percent N, NDiethyl-meta-toluamide (DEET), 20 percent picaridin, 30 percent oil of lemon eucalyptus, or 20 percent IR3535 for a child less than 18 years of age.

Covered products
Covered products have been selected based on guidance from the Centers for Disease Control and include the recommended amount of the active ingredient. Please download the Zika Products Pharmacy Assistance Chart for a current list of covered mosquito repellents.

Other Benefits Available Through Texas Medicaid
The following benefits are covered under current Texas Medicaid and may be helpful to clients who contract the Zika virus:

  • Family planning services
  • Contraceptives, including long-acting reversible contraceptives
  • Diagnostic testing
  • Targeted case management
  • Physical therapy
  • Long term services and support
  • Acetaminophen and oral electrolytes for Zika symptoms
  • Potential coverage for additional ultrasounds for pregnant women

Additional Resources

Questions?
Prescribers with questions may contact the patient’s MCO provider line. For patients in FFS, prescribers may send questions to VDP_Formulary@hhsc.state.tx.us.

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