LONG ACTING REVERSIBLE CONTRACEPTION ( LARC ) - INTRAUTERINE DEVICES (IUD'S) AND NEXPLANON IMPLANTS *

Effective Date: 
Thu, 02/26/2009
Reviewed: 
Fri, 03/19/2021
Revised: 
Fri, 03/19/2021
Policy: 

LARC are available for UCSC patients from trained UCSC clinicians.

Procedure: 

PRIOR TO INSERTION

Patients who would like to get LARC inserted need to have an assessment by a clinician.  The Pharmacy staff will ensure that there are enough products on hand in the Pharmacy and stocked in the designated secure locations in the clinic.  Stock and expiration dates will be checked by the Pharmacy staff weekly.  The clinician will document the product and the Lot and Expiration Date in the electronic medical record and on the patient form.

TIMING OF REPLACEMENTS
Long Acting Reversible Contraception (LARC) devices such as IUD's and Nexplanon implants can be changed and inserted when they are close to expiring as is done according to community standards. Early changes would be at a maximum of 6 months due, as can be ascertained to the best of our ability, and that would typically be for a good reason, such as travel abroad, Peace Corps etc. 
This excludes exchanges for appropriate medical reasons such as side effects or other medical issues.  
 

INSERTION

The clinician will select the appropriate LARC from the locked cabinet in a procedure room and insert it, using the back up if needed.  The clinician will document the product, the Lot Number and the Expiration Date in the electronic medical record. The clinician will send a prescription to Pharmacy, and attach a patient ID sticker to the empty LARC box.   The charge for the LARC is embedded within the procedure code.

POST PROCEDURE

After the procedure, the Medical Assistant (or RN) will bring the empty box, with the patient sticker attached, to the Pharmacy.  The Pharmacy staff will hand replacement LARC to the MA to restock the locked cabinet.  At that time, the Pharmacy staff will enter the prescription sent by the Clinician into the pharmacy software and note the Lot and Expiration Date in the "SIG" from the returned box.

EXPULSION OR FAILED INSERTION

If there was an expulsion or a failed insertion, the product should be disposed of - and if grossly contaminated, put into a red biohazard bag.  The Medical Assistant will still bring the box with the patient name to the Pharmacy.  The Pharmacy staff will begin a process for replacement.  

REPLACEMENT OF AN IUD

  • Contact Billing staff if any billing adjustment is anticipated
  • Dropped or contaminated product must be reported using the form from the manufacturer, with a call if it has been in contact with a patient.  This report must be made within 1 week.
  • Expulsion or removal for medical reasons of a product must also be reported, on a different form.  This report must be made within 30 days of removal and can only be replaced if within 90 days of insertion

Procedure for requesting patient refund following removal or expulsion of:

Paragard:

The UCSC account # is through the pharmacy and will be recognized by providing the pharmacy phone # 831-459-2360
Request that Paragard send shipping information to Pharmacy Fax 831-459-3564.  Submit any required information. These responses may need the assistance of the provider, and may include:

Was the patient examined prior to the procedure?
Were they sounded ( measurement of uterus?) 
Was a tenaculum used?
Describe if they are anteverted/retroverted/thyroid/cyst/polyps/cervical stenosis. 
Did they receive any treatment prior to procedure?
Have they been pregnant? 
What caused the failed insertion?

Was it: 

  • The device?
  • Patients anatomy?
  • Provider error:

Have they had IUD in the past? When? 
Was there a successful insertion?

Contact: 800-322-4966

Failed Insertion:

  1. A Product Replacement Authorization is required immediately.
  2. All packaging and product required
  3. Refund/replacement determined on case by case basis

Medical removal:

  1. A Product Replacement Authorization is required.
  2. Expiration date and Lot # required.
  3. Product is not returned.
  4. Refund/replacement determined on case by case basis

Mirena/Skyla/Kyleena:

Contact: Rep at 510-409-7190
Failed Insertion :

  1. A refund is determined on a case by case basis.
  2. If IUD is dropped there is no refund.
  3. All packaging will be required
  4. Must contact rep asap

Medical Removal

  1. If IUD is paid for by Insurance, then Bayer will not refund.
  2. A refund will only be issued if the patient has paid for IUD out of pocket
    1. The rep must be contacted
    2. Must have Lot# and Expiration date
    3. Must have clinician verify medical necessity of removal
    4. Packaging and IUD are not required

Liletta

To process a replacement request, please visit 

www.lilettaaccessconnect.com. 

Go to > Resources > Practice > Downloadable Resources > Replacement Request Form

It is imperative that this procedure be followed in order to recoup any costs, or get a replacement since these products are expensive.  The physician is required to help complete the forms.