Medi-Cal Update

Pharmacy | July 2018 | Bulletin 924

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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
February 23, 2018 APALUTAMIDE Drug added, administration added, restriction added drugs cdl p1a (14)
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2. Drug Safety Communication: Adverse Effects from Fluoroquinolone Antibiotics

A new DUR Educational Article titled “Drug Safety Communication: Adverse Effects from Fluoroquinolone Antibiotics” (PDF format) is available on the DUR: Educational Articles page of the Medi-Cal website.

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3. ProDUR Update: Additive Toxicity Alert Now Focused Only On CNS Depressants

A new DUR Educational Article titled “ProDUR Update: Additive Toxicity Alert Now Focused Only On CNS Depressants” (PDF format) is available on the DUR: Educational Articles page of the Medi-Cal website.

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4. Restriction and Administration Updates for Hydroxyprogesterone Caproate

Effective for dates of service on or after August 1, 2018, NDC labeler code 64011 (AMAG Pharmaceuticals, Inc./Lumara Health) is added as a restriction for physician-administered drug hydroxyprogesterone caproate. A 1.1 mL auto-injector administration of this drug is also added.

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

Provider Manual(s) Page(s) Updated
Pharmacy physician (1)
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5. Authorized Drug Manufacturer Labeler Codes Update

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

Changes, effective February 23, 2018
NDC Labeler Code Contracting Company's Name
64011 LUMARA HEALTH

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 (14)
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6. 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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7. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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