Learn how Opill® is expanding access to safe and effective contraception in the US

Insurance coverage for Opill®

Step 1: Verify your coverage

Opill insurance coverage varies—check your plan details! Contact your provider using the number on your card or visit the member portal to confirm coverage options

Step 2: Check RX requirements

Opill is still available without a prescription, but some insurance plans may require one for coverage. Contact your plan to confirm if a prescription is needed for reimbursement.

Step 3: Using insurance at the pharmacy

Bring Opill and your insurance card to the pharmacy counter. Guide staff to process the claim using the pharmacy’s NPI number, and provide override code ‘42’ if the claim is rejected

Step 4: Reimbursement process

If issues arise with the insurance claim, purchase Opill out-of-pocket and submit the receipt for reimbursement. Contact your insurer for submission guidelines.

Still have questions?

Does my insurance cover the cost of Opill?
It might! Some insurers, like CVS Caremark, offer Opill at $0 out-of-pocket cost for their members, without a prescription! However, every plan is different so the first step to determine coverage is to contact your individual plan. You can do so by calling the number on the back of your insurance card or by logging on to your member portal to get the details.
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Will I need a prescription to have my insurance cover the cost of Opill?
Even though Opill is available without a prescription, some plans will only cover over-the-counter medicines if there is a prescription for that product. The first step to determine coverage is to contact your individual plan. You can do so by calling the number on the back of your insurance card or by logging on to your member portal to get the details.
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How do I use my insurance to pay for Opill?
The good news is that some insurers, like CVS Caremark, offer Opill at $0 out-of-pocket cost for their members, without a prescription! Every plan is different, though, so the first step to determine coverage is to contact your individual plan. You can do so by calling the number on the back of your insurance card or by logging on to your member portal to get the details. If you want to use your insurance, here’s how to work with your pharmacy to process your insurance to cover the cost of Opill:
  1. Take the pack of Opill you wish to purchase from the shelf to the pharmacy counter. It is necessary to go to the pharmacy because insurance cannot be processed at the registers in the front of the store, only at the pharmacy
  2. Provide the pack of Opill along with your insurance card and ask that they process the purchase through your insurance.
    • You may need to guide the pharmacy representative on how to process the purchase with insurance. Be your own advocate! Here’s some information and statements that may help:
      • If the pharmacy representative says they need an NPI number, you can say "Please use this pharmacy’s NPI number in the NCPDP field. The pharmacy’s NPI can be used in place of a doctors NPI."
      • If they say the claim is rejected, ask them to, "please use the submission clarification code value of ‘42' to override the rejection."
  3. If the pharmacy is still having issues processing the claim, you have the option to pay for the pack of Opill, and then submit your receipt to your insurer for reimbursement. Information on where to send this receipt can be obtained by calling the number on the back of your insurance card or by logging into your member portal.
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