Pharmacist Enrollment: Over-the-Counter and Immunizations

Pharmacist Background

Prescribing OTCs

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.

Administering Vaccines

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:

  1. Follow the Board of Pharmacy Rules outlined in 3CCR 719-1, 19.00.00.
  2. Render vaccinations consistent with the Pharmacist Vaccination list.

Administering Vivitrol

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

Enrollment

  1. Begin at the Provider Portal
  2. Enroll as:
    • Individual within a Group
    • Provider Type= 75
    • Specialty= 750 Pharmacist
  3. SSN is required for individual enrollment and screening
  4. NPI (type 1 for an individual)
  5. Taxonomy Required
  6. 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

  1. Validation of Pharmacist status (DORA license for in state, authorizing authority for out of state)
  2. Malpractice Insurance

Additional Information

  1. Pharmacists cannot bill directly, they are only the renderer on the medical claim. Pharmacists will be the prescriber on a pharmacy claim.
  2. Pharmacists are a limited risk level for screening.
  3. Out-of-state enrollments are allowed.
  4. Not Required:
    • Application Fee
    • W9
    • Electronic Funds Transfer (EFT)
    • Proof of Lawful Presence
    • Supervising Physician Signature Form
  5. Optional:
    • Medicare Enrollment
    • Network Participation (MCO/RAE)

How to Bill

Billing for Immunizations/Injections

  1. 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.
  2. Refer to the Immunization Billing Manual for details on how to bill immunizations through the medical benefit.
  3. For billing issues, contact DXC at (844)-235-2387.

Billing for Over-the-Counter Drugs

  1. Process claims as normal through the pharmacy point of sale system using the enrolled pharmacist's NPI as the prescriber.
  2. Refer to the Pharmacy Billing Manual for details on how to bill the pharmacy point of sale system.
  3. 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

Lozenge
Up to 288 units per fill

Patch
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

Chewable
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

Chewable
Up to 48 tablets per 30 days

Immunization List

Posted in the Immunization Billing Manual.

Pharmacist Immunization List CPT Codes Age Restrictions
Shingles 90736 60-65
Shingles 90750 50-65
Pneumococcal 90670 19 and up
Pneumoccocal 90732 19 and up
Td 90714 19 and up
TDaP 90715 19 and up

Injection List

Pharmacist Injections  J Code Age Restrictions
Vivitrol (Naltrexone)
*Effective 1/1/19*
J2315 18 and up