Medi-Cal Update

Pharmacy | March 2018 | Bulletin 916

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1. Code I Restriction Removed for Insulin Syringes, Any Size

Effective for dates of service on or after April 1, 2018, the Code I restriction for insulin use only is removed on Syringes, Insulin, any size. The Code I restriction remains on Syringes, Insulin U-500. The List of Medical Supplies: Billing Codes, Units and Quantity Limits is updated to reflect this change.

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2. In the Pharmacy: Pharmacists Furnishing Nicotine Replacement Products

A new DUR Educational Article titled “In the Pharmacy: Pharmacists Furnishing Nicotine Replacement Products” (PDF format) is available on the DUR: Educational Articles page of the Medi-Cal website.

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3. Authorized Drug Manufacturer Labeler Codes Update

The Drugs: Contract Drugs List Part 5 – Authorized Drug Manufacturer Labeler Codes section has been updated as follows.

Additions, effective April 1, 2018
NDC Labeler Code Contracting Company's Name
00316 CROWN LABORATORIES, INC.
10599 INTERSECT ENT, INC.
24201 CUSTOPHARM, INC. DBA LEUCADIA PHARMA
66794 PIRAMAL CRITICAL CARE
69680 VITRUVIAS THERAPEUTICS, INC.
69794 ULTRAGENYX PHARMACEUTICAL INC.
70482 ADAMAS PHARMA LLC
71143 OPTINOSE US, INC.
71287 KITE PHARMA, INCORPORATED
71394 SPARK THERAPEUTICS, INC.
71399 AKRON PHARMA INC.
   
Terminations, effective April 1, 2018
NDC Labeler Code Contracting Company's Name
42192 ACELLA PHARMACEUTICALS, LLC
67546 ROMARK LABORATORIES

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

Provider Manual(s) Page(s) Updated
Adult Day Health Care Centers
AIDS Waiver Program
Chronic Dialysis Clinics
Clinics and Hospitals
Expanded Access to Primary Care Program
General Medicine
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Multipurpose Senior Services Program
Obstetrics
Pharmacy
Rehabilitation Clinics
drugs cdl p5 (4, 6–8, 16–20)
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4. Updates to the List of Enteral Nutrition Products

Effective for dates of service on or after March 1, 2018, certain product information has changed on the List of Enteral Nutrition Products.

The manufacturers guarantee providers can purchase the listed products at or below the maximum acquisition cost (MAC), upon request, for dispensing to Medi-Cal fee-for-service outpatient recipients. Refer to the Enteral Nutrition Products section of the Part 2 manual for the MAC price suppliers' telephone numbers.

Effective for dates of service on or after June 1, 2018, products deleted from the List of Enteral Nutrition Products will no longer be reimbursable, even with an approved TAR or SAR. The manufacturers no longer guarantee the MAC for deleted products.

Note:

Listing of a product is not a guarantee of its availability. The product number approved on an authorization must be the same product number dispensed to the recipient and claimed for reimbursement by the provider.

Recipients affected by these changes should seek new prescriptions from their physician and new authorizations from their pharmacy provider for a comparable product on the List of Enteral Nutrition Products. Continuing care does not apply.

Medi-Cal recipients denied enteral nutrition products who believe the denial was in error may ask for a state hearing by contacting the California Department of Social Services at 1-800-743-8525 or 1-855-795-0634 or by sending a written request to:

California Department of Social Services
State Hearings Division
P.O. Box 944243, MS 9-17-37
Sacramento, CA  94244-2430

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