March 2018

Zika Prevention Member Benefit

Beginning Feb. 12, 2018, mosquito repellent for the prevention of the Zika virus became a continuous, year-round benefit for Texas Medicaid and the Children’s Health Insurance Program (CHIP). Approved notices are being finalized for clients (including Spanish translation) and providers.

Managed Care Organizations (MCO) should have begun adjudicating claims for mosquito repellent as of Feb. 12, 2018. MCOs that have not implemented system configurations must notify their Managed Care Compliance & Operations team and provide the expected completion date including any challenges.

Benefit Details

• Start date: Feb. 12, 2018
• Covered programs: Medicaid, CHIP, CHIP-perinatal
• Eligible members:
• Pregnant women of any age
• Females – ages 10 through 55
• Males – ages 14 and older
• The pharmacy benefit for approved mosquito repellents is limited to one can/bottle per prescription fill, with up to two fills allowable per calendar month.
• A prescription is required for claim approval of mosquito repellent when the standing order is not used by a pharmacy.

The standing order for mosquito repellent will remain in effect and available for use by pharmacies for Medicaid and CHIP members. The current standing order has an expiration of April 10, 2018, however, a renewed standing order will be distributed mid-March.

Access mosquito repellent benefit materials.

Please continue using TexasZika.org as a resource for information related to the Zika virus.