Injectable Formulary Drugs Not Reimbursable to Pharmacies
Family PACT (Planning, Access, Care and Treatment) policy states that injectable contraceptives and drugs will be reimbursed only to the physician offices, clinics and hospitals that administer the drugs, but not to the pharmacy providing the drug for such administration.
Any drug administered by a physician or clinic must be billed by the physician or clinic, not by the pharmacy providing the drug for such administration.
Effective for dates of service on or after April 1, 2010, pharmacy claims for the following injectable drugs will be denied.
| Cefoxitin Sodium 1 Gm (vial) | |
| Cefoxitin Sodium 2 Gm (vial) | |
| Ceftriaxone Sodium 250 mg (vial) | |
| Ceftriaxone Sodium (vial) | |
| Medroxyprogestrone Acetate 150 mg/ml (disposable syringe) | |
| Medroxyprogestrone Acetate 150 mg/ml (vial) | |
| Penicillin G Benzathine 1.2 mm/2ml (disposable syringe) | |
| Penicillin G Benzathine 2.4 mm/4ml (disposable syringe) |
Providers should review the Pharmacy and Clinic Formulary section and the Benefits: Primary Contraceptive Services section of the Family PACT Policies, Procedures and Billing Instructions manual. Providers may also refer to Pharmacy Claim Form (30-1): Special Billing Instructions and Physician-Administered Drugs – NDC sections in the appropriate Part 2 Medi-Cal provider manual for policy information about physician-administered drugs.
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