Pharmacist Enrollment: Over-the-Counter and Immunizations
Effective 11/1/2018, pharmacists can enroll as a provider with the Department and prescribe specified OTC products (the specific products are outlined near the bottom of the page). The drugs:
- Must be prescribed consistent with the Pharmacist OTC Prescriptive Authority list.
- Must follow the Board of Pharmacy Rules outlined in 3CCR 719-1.
- Must follow the Department’s Rules outlined in 10 CCR 2505-10, 8.800.
Effective 11/1/2018, pharmacists can enroll as a provider with the Department and once enrolled can administer specific vaccinations in pharmacy (the specific vaccinations are outlined near the bottom of the page) . Pharmacists must:
- Follow the Board of Pharmacy Rules outlined in 3CCR 719-1, 19.00.00.
- Render vaccinations consistent with the Pharmacist Vaccination list.
Effective 1/1/2019, the Department plans to implement HB 18-1007, which stipulates that if a pharmacy has entered into a collaborative practice agreement with one or more physicians for the purposes of administering Vivitrol, that the pharmacy where the injection is administered shall receive reimbursement when an enrolled pharmacist administers it.
How to Enroll as a Pharmacist
- Begin at the Provider Portal
- Enroll as:
- Individual within a Group
- Provider Type= 75
- Specialty= 750 Pharmacist
- SSN is required for individual enrollment and screening
- NPI (type 1 for an individual)
- Taxonomy Required
- Affiliation to at least one pharmacy (PT09 or PT62); it is encouraged that you list all affiliated pharmacies on the application
Documents Required with Application
- Validation of Pharmacist status (DORA license for in state, authorizing authority for out of state)
- Malpractice Insurance
- Pharmacists cannot bill directly, they are only the renderer on the medical claim. Pharmacists will be the prescriber on a pharmacy claim.
- Pharmacists are a limited risk level for screening.
- Out-of-state enrollments are allowed.
- Not Required:
- Application Fee
- Electronic Funds Transfer (EFT)
- Proof of Lawful Presence
- Supervising Physician Signature Form
- Medicare Enrollment
- Network Participation (MCO/RAE)
How to Bill
Billing for Immunizations/Injections
- Process claims as normal through the medical benefit using:
- The pharmacies NPI as the billing provider,
- The pharmacists NPI as the rendering provider, and
- The physician on the standing order as the ordering provider.
- Refer to the Immunization Billing Manual for details on how to bill immunizations through the medical benefit.
- For billing issues, contact Gainwell Technologies at (844)-235-2387.
Billing for Over-the-Counter Drugs
- Process claims as normal through the pharmacy point of sale system using the enrolled pharmacist's NPI as the prescriber.
- Refer to the Pharmacy Billing Manual for details on how to bill the pharmacy point of sale system.
- For billing issues, contact Magellan at (800)-424-5725
OTC Prescriptive Authority List
Posted on the Pharmacy Webpage.
|Drug Categories||Age Restrictions||Quantity/Dosing Limits|
|Oral Emergency Contraceptive||None||1 package per fill|
|OTC Nicotine Replacement Therapy (patch, gum, lozenge)||None||Gum
Up to 220 units per fill
Up to 288 units per fill
Up to 30 patches per 30 days
|OTC Dextromethorphan (DM) Children’s Liquid||4 to 11 years old||Up to 150mL per 30 days|
|OTC Acetaminophen Children’s/Infant’s (only liquid/chewable)||2 to 11 years old||Liquid
Up to 240ml per 30 days
Up to 60 tablets per 30 days
|OTC Ibuprofen Children’s/Infant’s (only liquid/chewable)||6 months to 11 years old||Liquid
Up to 240ml per 30 days
Up to 48 tablets per 30 days
Posted in the Immunization Billing Manual.
|Pharmacist Immunization List||CPT Codes||Age Restrictions|
|Shingles SubQ||90736||60 and up|
|Shingles IM||90750||50 and up|
|Pneumococcal PCV13||90670||19 and up|
|Pneumococcal PPSV23||90732||19 and up|
|Td||90714||19 and up|
|TDaP||90715||19 and up|
|Influenza Fluzone High Dose||90662||65 and up|
|Influenza FluMist||90672||19 - 49|
|Influenza Flucelvax PF||90674||19 and up|
|Influenza Flublok PF||90682||19 and up|
|Influenza Fluarix PF||90686||19 and up|
|Influenza FluLaval PF||90686||19 and up|
|Influenza Fluzone PF||90686||19 and up|
|Influenza Afluria PF||90686||19 and up|
|Influenza FluLaval multi||90688||19 and up|
|Influenza Fluzone multi||90688||19 and up|
|Influenza Afluria multi||90688||19 and up|
|Influenza Flucelvax multi||90756||19 and up|
|Pharmacist COVID-19 Immunization List||CPT Codes||Administration Codes||Age Restrictions|
|Pfizer-Biontech Covid-19 Vaccine||91300||First Dose:
|16 and up|
|Moderna Covid-19 Vaccine||91301||First Dose:
|18 and up|
|Pharmacist Injections||J Code||Age Restrictions|
|Vivitrol (Naltrexone)||J2315||18 and up|