As of January 27, 2025, MassHealth has issued a standing order for prenatal vitamins and a standing order for over-the-counter (OTC) oral hormonal birth control. MassHealth members and Health Safety Net (HSN) patients are now able to get these medications free-of-charge without a prescription from their prescriber. Learn more about the standing orders at Publications, Notices, and Standing Orders for Pharmacy Providers | Mass.gov.
Standing orders are protocols approved by a qualified health care provider that allow pharmacists to dispense medications, tests, or vaccines without requiring prescriptions from individual prescribers. In Massachusetts, standing orders exist for emergency contraception and naloxone through the Department of Public Health. MassHealth is issuing standing orders for over-the-counter (OTC) oral hormonal birth control and prenatal vitamins. Although both are available OTC, MassHealth requires prescriptions for OTCs. The standing orders will allow a pharmacist to bill MassHealth for these OTC products.
These new standing orders have been established for the dispensing of prenatal vitamins to MassHealth members and HSN patients of reproductive age who state they are capable of becoming pregnant, are considering pregnancy, attempting to become pregnant, pregnant, or nursing; and for dispensing of OTC birth control to MassHealth members and HSN patients who wish to prevent pregnancy.
Find below summaries of the standing orders; please review the standing orders in full as the summaries do not include all relevant information.
Prenatal Vitamins
Prenatal vitamins are an important part of prenatal care to help ensure that the parent and baby get the nutrients needed during pregnancy and breastfeeding.
- Pharmacists may dispense up to a 90 days’ supply of prenatal or multivitamin containing ≥ 400 mcg of folic acid.
- The pharmacist must ask if the patient is:
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- Pregnant
- Planning on becoming pregnant
- Nursing
- Has a history of neural tube defects
- Or if there is a possibility the patient will become pregnant.
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- The pharmacist must counsel on contraindications, use, administration, and side effects, and must advise the patient to follow up and consult with their primary care physician or OB-GYN.
- The pharmacist must not dispense if there is a known hypersensitivity to folic acid or any component of the formulation.
Over-the-counter (OTC) Oral Hormonal Birth Control
Oral hormonal birth control, when taken correctly, can help reduce the likelihood of unwanted pregnancy.
Currently, Opill® (norgestrel) is the only FDA approved OTC oral contraceptive.
- Pharmacists may dispense up to a 365 days’ supply of Opill®.
- Pharmacists must confirm the member:
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- States that they are of reproductive age and potential
- Has no drug-drug interactions.
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- Pharmacists must counsel members on:
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- The importance of consistent timing of dose and what to do if a dose is missed.
- The fact that OTC oral hormonal contraceptives should not be used for emergency contraception and do not protect against HIV/AIDS or other sexually transmitted infections.
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- The pharmacist must also counsel on contraindications, use, administration, and side effects, and must advise the patient to follow up and consult with their primary care physician or OB-GYN.