...The birth control implant, also known as Nexplanon, is a small rod inserted in a patient’s arm, which prevents pregnancy. It is one of the most reliable kinds of birth control with a ninety-nine percent effectiveness rate. One of the reasons it is so effective is because, unlike the pill, there is no chance of forgetting to take it and becoming pregnant. It is cost efficient and covered by most health insurance plans with no out of pocket cost. Nexplanon prevents pregnancy in two different ways. Its progestin thickens the mucus on the patients’ cervix, which prohibits the sperm from swimming through to the egg. If the sperm cannot reach the egg, pregnancy cannot happen. The other way the implant prevents pregnancy is by ovulation. Ovulation is when progestin stops the eggs from leaving the patients ovaries. When the eggs are not realized from the ovaries, there is no way it can reach a sperm therefor the patient cannot become pregnant. Nexplanon also changes the lining of the patient’s uterus. If the implant inserted into the patients arm within the first five days of their period, it protects them...
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...Part II POLICIES AND PROCEDURES FOR THE PHYSICIANS’ INJECTABLE DRUG LIST GEORGIA DEPARTMENT OF COMMUNITY HEALTH DIVISION OF MEDICAL ASSISTANCE PLANS Published October 1, 2013 PREFACE The Physicians’ Injectable Drug List (PIDL) manual contains basic information regarding Georgia’s Fee for Service (FFS) Medicaid and PeachCare for Kids programs and should be used in conjunction with Policies and Procedures Manual for Medicaid and PeachCare for Kids Part I, Part II Policies and Procedures Manual for Physician Services, and other applicable program manuals. We urge you and your office staff to familiarize yourselves with the contents of this manual and refer to it when questions arise. Use of the manuals will assist in the elimination of misunderstandings concerning the coverage levels and billing procedures that can result in delays of claims processing or payments, inaccuracies and/or denials. The PIDL is reviewed and updated quarterly, it is re-priced annually. Drugs that are not re-priced by the manufacturer or are no longer manufactured, or obsolete may not be re-priced or changed— refer to the Schedule of Maximum Allowable Payments (Appendix A) in this manual. For quality purposes, the PIDL is periodically purged of drugs with no or low (fewer than 50 units of service annually) utilization over a three (3) year period; except for orphan drugs and certain chemotherapeutic agents. Requests for coverage of purged drugs will be considered on a case-bycase...
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