Medi-Cal and Family Planning, Access, Care and Treatment (Family PACT) programs reimburse medication treatment of a sexually transmitted infection (STI) and reimburse for medication quantities sufficient to prevent reinfection by sex partners of the beneficiary. Expedited Partner Therapy (EPT) is the clinical practice of treating sex partners of patients diagnosed with a STI without first examining the partner. This form of reinfection prevention usually involves patient-delivered partner therapy, an evidence-based practice to reduce reinfection. Since repeat infections are often due to untreated partners, ensuring all recent partners have been treated is a core aspect of clinical management of patients diagnosed with chlamydia, gonorrhea and/or trichomoniasis.
Medi-Cal and Family PACT cover medically necessary services for the treatment of STIs. If a Medi-Cal or Family PACT provider determines preventative treatment of sex partners is necessary to prevent gonorrhea, chlamydia and/or trichomoniasis reinfection, the provider may dispense an appropriate amount of medication directly to the Medi-Cal or Family PACT patient to provide to partner(s). Alternatively, the provider may provide a prescription written in the beneficiary’s (patient’s) name for medications sufficient to treat both the patient and the partner(s).
For Medi-Cal family planning programs, pursuant to family planning encounters, treatment regimens for chlamydia, gonorrhea and/or trichomoniasis may be dispensed in the clinic or by prescription to be dispensed by a pharmacy. For more information about family planning-related services, providers may refer to the Family Planning section of the appropriate Part 2 section of the Medi-Cal Provider Manual or the ben fam rel section of the Family PACT Policies, Procedures and Billing Instructions Manual. For non-family planning encounters, Medi-Cal covers treatment regimens for chlamydia, gonorrhea and/or trichomoniasis by prescription only.
For additional prescribing and clinical guidelines on treating partners of patients diagnosed with STIs, providers may review guidance from the U.S. Centers for Disease Control and Prevention (CDC) and the California Department of Public Health (CDPH).
California legislation allowing EPT
In 2001, Senate Bill 648 (Ortiz, Chapter 835, Statutes of 2000) amended California law to allow EPT for chlamydia. In January 2007, Assembly Bill 2280 (Leno, Chapter 771, Statutes of 2006) amended the law to allow EPT for gonorrhea and other sexually transmitted infections.
The current law, Health and Safety Code Section 120582, allows specified health care providers to prescribe and/or dispense, furnish or otherwise provide antibiotic therapy for sex partners of individuals infected with Chlamydia trachomatis, Neisseria gonorrhoeae, or other STIs as determined by the CDPH, even if the provider has not performed an exam of the partner(s). The law provides an exception to the Medical Practice Act, which states that prescribing, dispensing or furnishing dangerous drugs without a good-faith prior examination and medical indication constitutes unprofessional conduct.
To reduce the spread of STIs, the CDC and the CDPH recommend EPT to treat partners of persons with chlamydia or gonorrhea without waiting for a clinical evaluation.
A prescriber can legally write prescriptions to include the partner(s) in the following ways:
- The prescriber may write a separate prescription if the patient provides the partner’s name.
- The prescriber may write a single prescription for both the patient and the partner by adding the partner’s name to the prescription and increasing the quantity appropriately.
- The prescriber may simply add “partner(s)” to the prescription and increase the quantity appropriately.
The preferred option is a separate prescription for each partner; however, all three options are valid prescriptions and can be filled by a pharmacist.
Medi-Cal and Family PACT reimbursement for STI reinfection prevention
Effective February 1, 2020, Medi-Cal and Family PACT have updated their policy for reimbursement for EPT:
- For the prevention of reinfection from chlamydia, gonorrhea, and trichomoniasis.
- Allowable by prescription for any visit type or dispensed in clinic for family planning-related visits only.
- Reimbursement for client dose and up to five partner doses per dispensing.
- Prescriptions must be written in the name of the enrolled client to be covered by Medi-Cal.
References for EPT guidelines