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Oral Contraceptive PillsThe Henry J Kaiser Family Foundation

Oral Contraceptive PillsThe Henry J Kaiser Family Foundation 2025

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The document is a Drug Coverage Review Request form for contraceptive agents, requiring prescriber and patient information. It outlines the need for coverage review by Medco, which manages prescription drug benefits. The form includes sections for gender identification, purpose of the drug prescription, and physician signature, with instructions to fax the completed form for benefit determination.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the prescriber information. Enter the MD's first and last name, address, city, state, zip code, phone number, and optional DEA number.
Next, provide the patient’s information. Fill in the cardholder’s ID#, patient’s last and first name, date of birth, address, city, state, zip code, and phone number.
In Section A, answer the questions regarding the patient's gender and the purpose of the drug prescription by selecting the appropriate options.
Finally, ensure that you sign in Section B with your physician signature and date before submitting.
Fax the completed form to 1 800 837-0959 without a cover sheet as instructed.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is birth control free in California with insurance?

What are my options for birth control? If you have health insurance through Covered California or Medi-Cal, youre covered! You have the right to get any FDA-approved method of birth control, without any cost to you. That means you cannot be charged any co-pays or cost sharing.

How much does birth control cost with Kaiser?

All FDA-approved, -granted, or -cleared contraceptives are covered at no cost. This means that there isnt a copay, coinsurance, or deductible payment for these services. Which contraceptive drugs and devices are covered?

Is the pill still free?

Contraception is free and confidential, including for young people under the age of 16.

Does Kaiser cover birth control pills?

And most Kaiser Permanente members can get certain types of birth control methods at low or no cost.

Do you get birth control for free?

You can get contraception, including emergency contraception, for free from: sexual health clinics, also called family planning or contraception clinics.

Are birth control pills covered by insurance?

Most insurance plans must cover all methods of birth control at no cost to you, including the pill. However, some plans only cover certain brands of pills or generic versions.

Who funded the birth control pill?

Katharine McCormick provided almost every single dollar necessary to develop the oral contraceptive. For a woman once described as being rich as Croesus, philanthropic acts were nothing unusual.

Oral Contraceptive PillsThe Henry J Kaiser Family Foundation 2025

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