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Arizona

Payer Coverage Reimbursement Other

Aetna US Healthcare

Mifeprex is covered to the same extent as surgical abortions.

Reimbursement for a patient's non-primary care physician uses E/M codes for office visits; the drug is reimbursed using code J3490 and is paid based on the physician's invoice cost. If the patient's primary care physician is providing Mifeprex and s/he is capitated, the office visits are under the capitation. The drug cost is reimbursed separately based on the invoice cost.

OB/GYNS will not need a referral to provide Mifeprex to their patients. If an internist or family practice physician is providing Mifeprex but s/he is not the primary care provider for the patient, a referral will be needed.

Blue Cross/Blue Shield of Arizona

Mifeprex is covered to the same extent as surgical abortions.

Office visits are reimbursed using regular E&M codes. Providers should use S0190 for Mifeprex and S0191 for misoprostol.

Family practitioners are covered. No referral is needed if the family practitioner is not the patient’s primary care physician.

CIGNA

Mifeprex is covered to the same extent as surgical abortion.

Mifeprex should be submitted using S0190 and misoprostol using S0191. Regular E&M codes should be used for office visits.

Family practitioners are covered. A referral is needed if a patient obtains Mifeprex from a family practitioner who is not her PCP.

Great-West/One Health Plan

Mifeprex is covered to the same extent as surgical abortions.

Office visits are reimbursed using regular E&M codes. Providers should use S0190 for Mifeprex and S0191 for misoprostol.

Family practitioners are covered. A referral is needed if the family practitioner is not the patient’s primary care physician.

Mayo Health Plan

Mifeprex is covered to the same extent as surgical abortions.

Office visits are reimbursed using regular E&M codes. Providers should use S0190 for Mifeprex and S0191 for misoprostol.

Ob/gyns and family practitioners are covered. No referral is needed if the family practitioner is not the patient’s primary care physician.

United HealthCare

Mifeprex is covered to the same extent as surgical abortions.

Office visits are reimbursed using regular E&M codes. Mifeprex and misoprostol should be submitted using S0190.

Family practitioners and ob/gyns are covered. No referral is needed if the family practitioner is not the patient’s primary care physician. United HealthCare will not reimburse if Mifeprex is given to someone whose pregnancy is past 49 days LMP.

State Medicaid Information

Health Care Cost Containment of Arizona
801 E. Jefferson
Phoenix, AZ 85034
Toll free: 1-800-523-0231 (national)
TTY: 1-602-417-4191,br> Spanish: 1-602-417-7700
www.ahccs.state.az.us

IMPORTANT SAFETY INFORMATION

Although cramping and bleeding are an expected part of ending a pregnancy, rarely, serious and potentially life-threatening bleeding, infections, or other problems can occur following a miscarriage, surgical abortion, medical abortion, or childbirth. Prompt medical attention is needed in these circumstances. Serious infection has resulted in death in a very small number of cases; in most of these cases misoprostol was used in the vagina. There is no information that use of Mifeprex and misoprostol caused these deaths. If you have any questions, concerns, or problems, or if you are worried about any side effects or symptoms, you should contact your provider.

Be sure to contact your provider promptly if you have any of the following:

Heavy Bleeding. Contact your provider right away if you bleed enough to soak through two thick full-size sanitary pads per hour for two consecutive hours or if you are concerned about heavy bleeding. In about 1 out of 100 women, bleeding can be so heavy that it requires a surgical procedure (surgical abortion/D&C) to stop it.

Abdominal Pain or “Feeling Sick”. If you have abdominal pain or discomfort, or you are “feeling sick”, including weakness, nausea, vomiting, or diarrhea, with or without fever, more than 24 hours after taking misoprostol, you should contact your provider without delay. These symptoms may be a sign of a serious infection or another problem (including an ectopic pregnancy, a pregnancy outside the womb).

Fever. In the days after treatment, if you have a fever of 100.4°F or higher that lasts for more than 4 hours, you should contact your provider right away. Fever may be a symptom of a serious infection or another problem (including an ectopic pregnancy).

Take your MEDICATION GUIDE with you. When you visit an emergency room or a provider who did not give you your Mifeprex, you should give them your MEDICATION GUIDE so that they understand that you are having a medical abortion with Mifeprex.

Mifeprex* is a registered trademark
of Danco Laboratories, LLC
1-877-4 Early Option
1-877-432-7596
info@earlyoptionpill.com
FDA approved since 2000.
A safe and effective non-surgical option for ending early pregnancy.