Medi-Cal Update

Pharmacy | May 2015 | Bulletin 848

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1. Medi-Cal List of Contract Drugs

The following provider manual section(s) have been updated: Drugs: Contract Drugs List Part 1 – Prescription Drugs and Drugs: Contract Drugs List Part 4 – Therapeutic Classifications.

A summary of drugs that have been added or changed is shown below. For additional information, click on the link to the manual section and scroll to the page indicated or use the find feature to search for the particular drug.

Added Drug(s)

Effective Date Drug Summary of Changes Page(s) Updated
June 1, 2015 BUPRENORPHINE Drug added, restriction added, administration added drugs cdl p1a (26)
June 1, 2015 DAPAGLIFLOZIN Drug added, restriction added, administration added drugs cdl p1a (50)
June 1, 2015 DAPAGLIFLOZIN/METFORMIN HCL EXTENDED-RELEASE Drug added, administration added drugs cdl p1a (50)
July 1, 2015 CETUXIMAB Drug added, restriction added, administration added drugs cdl p1a (34)
July 1, 2015 IPILIMUMAB Drug added, restriction added, administration added drugs cdl p1b (44)
July 1, 2015 IXABEPILONE Drug added, restriction added, administration added drugs cdl p1b (47)

Changed Drug(s)

Effective Date Drug Summary of Changes Page(s) Updated
April 1, 2015 SUNITINIB MALATE Strength added drugs cdl p1d (9)
June 1, 2015 BUPRENORPHINE/NALOXONE Administration added, restrictions added, restriction removed drugs cdl p1a (26)
June 1, 2015 FLUVOXAMINE MALEATE Restriction removed drugs cdl p1b (23)
June 1, 2015 ILOPERIDONE Restriction added drugs cdl p1b (37)
July 1, 2015 DASATINIB Restriction added drugs cdl p1a (52)
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2. Incontinence Supply Products: Presto and Hartmann Products Updated

Effective for dates of service on or after July 1, 2015, newly contracted Hartmann disposable underpads and Presto pads have been added to the lists of incontinence products. In addition, the HCPCS billing code and maximum acquisition cost (MAC) changed for two Presto contracted disposable underpad products.

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
Durable Medical Equipment
Pharmacy
incont prod shield (10); incont prod und (5, 6)
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3. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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