Medi-Cal Update

Pharmacy | February 2018 | Bulletin 914

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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 and 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
January 1, 2018 ESLICARBAZEPINE ACETATE Drug added, administration added drugs cdl p1b (9)

Changed Drug(s)
Effective Date Drug Summary of Changes Page(s) Updated
August 25, 2017 VANDETANIB Restriction added drugs cdl p1d (27)
October 1, 2017 THIOGUANINE Restriction added drugs cdl p1d (15)
December 1, 2017 BOSUTINIB Strength added drugs cdl p1a (24)
January 2, 2018 BRIGATINIB Restriction added, strength added drugs cdl p1a (24)
March 1, 2018 BUSULFAN Restrictions added drugs cdl p1a (28)
March 1, 2018 CHLORAMBUCIL Restrictions added drugs cdl p1a (35)
March 1, 2018 CINACALCET HCL Restriction added drugs cdl p1a (38)
March 1, 2018 FLUTICASONE PROPIONATE Restrictions added drugs cdl p1b (23)
March 1, 2018 FLUTICASONE PROPIONATE AND SALMETEROL Restriction added drugs cdl p1b (23)
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2. Medi-Cal Pharmacy Provider Self-Attestation Period Closing at 12 a.m.

The online attestation portal for fee-for-service Medi-Cal pharmacy providers seeking the higher of two professional dispensing fees as part of the forthcoming reimbursement changes for covered outpatient drugs closes at 12 a.m. on March 1, 2018. Attestations will not be accepted after that time.

As has been published in previous Medi-Cal Updates, the Department of Health Care Services (DHCS) is implementing a new fee-for-service reimbursement methodology for covered outpatient drugs. Part of this new methodology is a two-tiered professional dispensing fee based on a pharmacy provider's total (Medi-Cal and non-Medi-Cal) annual pharmacy claim volume ($13.20 if fewer than 90,000 claims per year; $10.05 if 90,000 or more). Reporting the claim volume is a self-attestation process, which is submitted electronically and must be done annually.

Note:

DHCS policy is that a claim is equivalent to a dispensed prescription; therefore, the attestation is for the total dispensed prescription volume.

Only fee-for-service Medi-Cal providers dispensing fewer than 90,000 total prescriptions per calendar year are eligible to receive the higher of the two professional dispensing fees and must complete this attestation in order to receive it.

The attestation period for both the 2016 and 2017 calendar years opened January 15, 2018, and closes at 12 a.m. on March 1, 2018. Separate attestations must be submitted for each calendar year. The attestation for each calendar year reporting period determines the professional dispensing fee component of the pharmacy claim reimbursement for claims with dates of service within the State's following fiscal year. As an example, a 2017 calendar year claim volume attestation determines the professional dispensing fee for claims within the State's 2018 – 2019 fiscal year (dates of service of July 1, 2018, through June 30, 2019).

For additional information, providers can refer to the Pharmacy Provider Self-Attestation FAQs or the Pharmacy Reimbursement Project page on the DHCS website. For inquiries not covered in either, providers may call the Telephone Service Center at 1-800-541-5555 and select the following options:

  1. Option 1 for English or Option 2 for Spanish
  2. Option 1 for Provider
  3. Option 4 for Technical Help Desk
  4. Option 2 for Pharmacy
  5. Option 1 for Provider
  6. Option 1 for NPI (enter NPI followed by the # sign)
  7. Option 2 for Pharmacy

After following the steps above, the caller will be directed to an agent.

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3. Drug Safety Communication: New Age Limit for Opioid Cough and Cold Medicines

A new DUR Educational Article titled “Drug Safety Communication: New Age Limit for Opioid Cough and Cold Medicines” (PDF format) is available on the DUR: Educational Articles page of the Medi-Cal website.

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4. Medical Supplies Updates: Wound Care Advanced Dressings

Effective for dates of service on or after April 1, 2018, the List of Contracted Wound Care Advanced Dressings is updated. Products by BSN medical, Inc and Safe ’n Simple are added to the list. In addition, the manufacturer for Therabond products is changed to Argentum Medical.

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5. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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