Pharmacist Prescribers

​Effective January 1, 2019, qualified pharmacists and pharmacies may enroll with Maryland Medicaid as a Pharmacist Prescriber provider type. Maryland Senate Bill 363 (2017) allows qualified pharmacists to prescribe certain contraceptive medications and self-administered contraceptive devices.

In order for Medicaid to reimburse providers for these services, a pharmacy must take three steps:

  1. The pharmacy must obtain a new type 2 National Provider Identifier (NPI) through the National Plan and Provider Enumeration System (NPPES) for the location it intends to enroll as a Pharmacist Prescriber. The NPPES website is https://nppes.cms.hhs.gov.
  2. The pharmacy will enroll as a group pharmacist prescriber and need to affiliate with at least one qualified pharmacist in order to submit the application.
  3. The individual qualified pharmacist must enroll as a Pharmacist Prescriber renderer. Please note: Any individual pharmacist who does not have a type 1 NPI will need to obtain one in order to apply as a Pharmacist Prescriber.

Enrollment
Maryland Medicaid enrolls providers via electronic Provider Revalidation and Enrollment Portal (ePREP). ePREP is the one-stop shop for provider enrollment, re-enrollment, revalidation, information updates and demographic changes.

Pharmacies who intend to provide this service to Medicaid participants should apply as a Pharmacist Prescriber using their new type 2 NPIs. The pharmacy will enroll as a group pharmacist prescriber and need to affiliate with at least one qualified pharmacist in order to submit the application.

The individual qualified pharmacist must apply as a rendering Pharmacist Prescriber provider. The pharmacist will need to upload documentation of his or her Board-approved training completion as an addendum to the application.

For ePREP resources, including instructions for providers and credentialers, visit health.maryland.gov/ePREP.

To apply, visit ePREP.health.maryland.gov

ePREP Call Center: 1-844-4MD-PROV (1-844-463-7768)

Billing
Once enrolled, Pharmacist Prescribers may bill for the patient assessment rendered. The purpose of the patient assessment is to determine whether to prescribe contraceptives and which contraceptive to prescribe. To be reimbursed for the patient assessment, the Pharmacist Prescriber provider type must bill via a CMS-1500 form. Pharmacies should NOT bill Conduent for the patient assessment.

For first-time office visits, the Pharmacist Prescriber group will bill new patient code 99201. For established patient visits, the group will bill established patient code 99211. The Maryland Medical Assistance Program’s reimbursement rates and procedures for payment are contained in the Professional Services Provider Manual and Fee Schedule.

Please direct questions regarding your participation in Maryland Medicaid as a pharmacist prescriber to MDH.pharmacistprescribers@maryland.gov

Please direct questions regarding the Board-approved training program to the Maryland Board of Pharmacy.

Resources
Senate Bill 363
Maryland Board of Pharmacy