Medi-Cal Update

Pharmacy | June 2018 | Bulletin 922

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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
August 17, 2017 INOTUZUMAB OZOGAMCIN Drug added, administration added, restriction added drugs cdl p1b (41)
April 1, 2018 COPANLISIB Drug added, administration added, restriction added drugs cdl p1a (47)

Changed Drug(s)
Effective Date Drug Summary of Changes Page(s) Updated
October 1, 2017 GEMTUZUMAB OZOGAMICIN Restriction added, administration added drugs cdl p1b (28)
January 1, 2018 NIVOLUMAB Strength added drugs cdl p1c (7)
February 27, 2018 IBRUTINIB Strength added drugs cdl p1b (37)
March 21, 2018 IBRUTINIB Administration added drugs cdl p1b (37)
April 1, 2018 OLARATUMAB Strength added drugs cdl p1c (14)
July 1, 2018 ENOXAPARIN SODIUM Restriction removed drugs cdl p1b (5)
July 1, 2018 ESOMEPRAZOLE MAGNESIUM Restriction removed drugs cdl p1b (9)
July 1, 2018 MONTELUKAST SODIUM Restriction removed drugs cdl p1b (72)
July 1, 2018 NORETHINDRONE AND ETHINYL ESTRADIOL Restriction removed drugs cdl p1c (9)
July 1, 2018 PANTOPRAZOLE SODIUM Drug suspension removed, restriction removed, administration changed, strength added drugs cdl p1c (21)
August 1, 2018 DESOGESTREL AND ETHINYL ESTRADIOL Restriction changed drugs cdl p1a (54)
August 1, 2018 DROSPIRENONE/
ETHINYL ESTRADIOL/
LEVOMEFOLATE CALCIUM
Restriction changed drugs cdl p1a (65)
August 1, 2018 ESTRADIOL VALERATE/
DIENOGEST
Restriction changed drugs cdl p1b (11)
August 1, 2018 ETHYNODIOL DIACETATE AND ETHINYL ESTRADIOL Restriction changed drugs cdl p1b (13)
August 1, 2018 ETONOGESTREL AND ETHINYL ESTRADIOL Restriction added drugs cdl p1b (14)
August 1, 2018 LEVONORGESTREL AND ETHINYL ESTRADIOL Restriction changed drugs cdl p1b (55)
August 1, 2018 NORELGESTROMIN AND ETHINYL ESTRADIOL Restriction added drugs cdl p1c (7)
August 1, 2018 NORETHINDRONE Restriction changed drugs cdl p1c (8)
August 1, 2018 NORETHINDRONE ACETATE AND ETHINYL ESTRADIOL Restriction changed drugs cdl p1c (8)
August 1, 2018 NORETHINDRONE AND ETHINYL ESTRADIOL Restriction changed drugs cdl p1c (9)
August 1, 2018 NORETHINDRONE AND MESTRANOL Restriction changed drugs cdl p1c (10)
August 1, 2018 NORGESTIMATE AND ETHINYL ESTRADIOL Restriction changed drugs cdl p1c (11)
August 1, 2018 NORGESTREL AND ETHINYL ESTRADIOL Restriction changed drugs cdl p1c (11)
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2. Upcoming Pharmacy Fee-For-Service Reimbursement Changes for Covered Outpatient Drugs

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. Although the policy effective date mandated by the Centers for Medicare & Medicaid Services (CMS) is April 1, 2017, it will take the state's Fiscal Intermediary additional time to update the claims processing system to reimburse using the new methodology. DHCS anticipates that the system changes will be implemented in late 2018. After system implementation, DHCS intends to make retroactive adjustments for all claims with dates of service between the policy effective date of April 1, 2017, and the date of system implementation. DHCS will engage stakeholders in the upcoming months with regards to how these claim adjustments will be rolled out.

As outlined in California's State Plan Amendment 17-002 approved by CMS on August 25, 2017, the new reimbursement methodology reflects the following changes:

Pharmacy providers are reminded that until such time that DHCS implements the new fee-for-service reimbursement, the pharmacy dispensing fee shall be reimbursed according to the previous methodology ($7.25 retail or $8 for Long Term Care pharmacies). This includes the dispensing fee submitted for 340B drug claims by covered entities and their contract pharmacies pursuant to Welfare and Institutions Code (W&I Code), Section 14105.46.

Providers should refer to the Pharmacy Reimbursement Project page on the DHCS website for access to additional project resources, including the General Project FAQs. DHCS strongly encourages the Medi-Cal pharmacy fee-for-service provider community to closely monitor upcoming Medi-Cal Update pharmacy bulletins for additional information regarding any future stakeholder events, as well as implementation updates.

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3. Correction: No TAR Required for Copper IUDs

In a previous Medi-Cal Update published on May 31, 2018, the Department of Health Care Services (DHCS) introduced a new manual section titled Physician Administered Drugs in the Part 2 Medi-Cal Pharmacy provider manual. The new section stated in error that a Treatment Authorization Request (TAR) is always required for copper intrauterine devices (IUDs).

A TAR is not required for copper IUDs. This information has been corrected in the Physician Administered Drugs section.

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

Provider Manual(s) Page(s) Updated
Pharmacy physician (1)
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4. 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 July 1, 2018
NDC Labeler Code Contracting Company’s Name
42385 LAURUS LABS LIMITED
59365 COOPERSURGICAL INC.
59917 ADARE PHARMACEUTICALS, INC.
69488 ADVANCED ACCELERATOR APPLICATIONS USA
69584 OXFORD PHARMACEUTICALS, LLC
70727 AERIE PHARMACEUTICALS, INC.
70954 NOVITIUM PHARMA LLC
71274 PHARMING HEALTHCARE INC.
71321 BRANDYWINE PHARMACEUTICALS, LLC
71332 RIGEL PHARMACEUTICALS, INC.
71709 METCURE PHARMACEUTICALS, INC.
71758 AVADEL SPECIALTY PHARMACEUTICALS LLC
71770 MEDUNIK USA

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 (8, 13, 18–20)
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5. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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