Pharmacist Prescribers

Effective January 1, 2019, qualified pharmacists and licensed pharmacies may enroll with Maryland Medicaid under the 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 licensed 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 rendering pharmacist prescriber 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 that 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. Please note: In order to enroll, pharmacies need to upload their pharmacy licenses to their ePREP applications. Please review Pharmacy License Upload Instructions for Pharmacist Prescriber Groups​
 
The individual qualified pharmacist must apply as a rendering Pharmacist Prescriber provider. The pharmacist will need to upload their professional pharmacist license, as well as documentation of 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 Prescriber groups 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 99202. For established patient visits, the group will bill established patient code 99211. Please use place-of-service code 01 (pharmacy). 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.pharmacistenrollment@maryland.gov

 

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

 

Resources

Frequently Asked Questions​ (Updated March 2021)​

ePREP Documentation Checklist for Pharmacist Prescribers

Pharmacy License Upload Instructions for Pharmacist Prescriber Groups

COMAR 10.09.21 Pharmacists (Medicaid regulations)

COMAR 10.34.40 Pharmacists Prescribing Contraceptives (Board of Pharmacy regulations)

Senate Bill 363

Maryland Board of Pharmacy

General Provider Transmittal No. 86