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Medi-Cal Update

Pharmacy | September 2020 | Bulletin 976

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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, changed or deleted 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.

Effective Date Drug Summary of Changes    Page(s) Updated
July 1, 2020 Rituximab-ABBS Drug added, strength added, labeler code added drugs cdl p1c (75)
drugs cdl p4 (9)
July 1, 2020 Trastuzumab-PKRB Drug added, strength added, labeler code added drugs cdl p1d (23)
drugs cdl p4 (9)
October 1, 2020 Empagliflozin/Linagliptin Drug added, strength added, labeler code added drugs cdl p1b (3)
drugs cdl p4 (15)
October 1, 2020 Empagliflozin/Linagliptin/Metformin HCL Drug added, strength added, labeler code added drugs cdl p1b (3)
drugs cdl p4 (15)
October 1, 2020 Empagliflozin/Metformin HCL Drug added, strength added, labeler code added drugs cdl p1b (3)
drugs cdl p4 (15)
October 1, 2020 Dabigatran Etexilate Mesylate Drug added, strength added, labeler code added drugs cdl p1a (53)
drugs cdl p4 (10)
October 1, 2020 Olodaterol HCL Drug added, strength added, labeler code added drugs cdl p1c (23)
drugs cdl p4 (10)
October 1, 2020 Tiotropium BR/Olodaterol HCL Drug added, strength added, labeler code added drugs cdl p1d (20)
drugs cdl p4 (10)

Effective Date Drug Summary of Changes    Page(s) Updated
April 1, 2020 Palbociclib Dosage added drugs cdl p1c (31)
October 1, 2020 Abacavir Sulfate, Lamivudine and Zidovudine Restriction changed drugs cdl p1a (1)
October 1, 2020 Aspirin/Extended-Release Dipyridamole Labeler code removed drugs cdl p1a (17)
October 1, 2020 Celecoxib Restriction removed drugs cdl p1a (37)
October 1, 2020 Diazepam Dosage added, restriction added, strength added, note added drugs cdl p1a (62)
October 1, 2020 Diclofenac Sodium Restriction removed, note removed drugs cdl p1a (63)
October 1, 2020 Diflunisal Restriction removed drugs cdl p1a (64)
October 1, 2020 Fenoprofen Restriction removed, note removed drugs cdl p1c (17)
October 1, 2020 Flurbiprofen Restriction removed drugs cdl p1b (23)
October 1, 2020 Glucagon (synthetic) Dosage added, restriction added drugs cdl p1b (31)
October 1, 2020 Ibuprofen Note removed drugs cdl p1b (39)
October 1, 2020 Indomethacin Note removed, package size removed drugs cdl p1b (41)
October 1, 2020 Insulin Glargine (rDNA origin) Restriction added drugs cdl p1b (43)
October 1, 2020 Linagliptin/Metformin HCL Dosage added, restriction added drugs cdl p1b (60)
October 1, 2020 Nelarabine Restriction added drugs cdl p1c (5)
October 1, 2020 Tiotropium Bromide Dosage added, restriction added, strength added drugs cdl p1d (20)
October 1, 2020 Topotecan HCL Restriction added drugs cdl p1d (22)

2. 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 October 1, 2020
NDC Labeler Code Contracting Company's Name
11788 AIPING PHARMACEUTICAL, INC.
42667 ACERUS PHARMACEUTICALS CORPORATION
69751 EVOFEM BIOSCIENCES, INC.
69880 CHIASMA, INC
69967 ARISE PHARMACEUTICALS LLC
70868 KEY THERAPEUTICS, LLC
72677 VIELA BIO, INC.
73302 HRA PHARMA AMERICA, INC.
73535 MORPHOSYS US INC.
Terminations, effective October 1, 2020
NDC Labeler Code Contracting Company's Name
00029 GLAXOSMITHKLINE
00091 SCHWARZ PHARMA, INC.
10511 PHOTOCURE, INC.
10888 BANNER PHARMACAPS INC.
13632 ROSEMONT PHARMACEUTICALS, LTD.
15127 SELECT BRAND DISTRIBUTORS
24856 THROMBOGENICS INC.
31357 INSPIRE PHARMACEUTICALS, INC.
43773 SLATE PHARMACEUTICALS, INC.
53097 THE PHARMA NETWORK, LLC
63717 HAWTHORN PHARMACEUTICALS
70403 ARU PHARMA INC.
70752 QUAGEN PHARMACUETICALS LLC
71717 MEGALITH PHARMACEUTICALS INC.
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 (2, 5–8, 10, 17–22)

3. Updates to Physician Administered Drugs List

The Physician-Administered Drugs section of the Pharmacy provider manual is updated. A summary of drug that was added is shown below.

Effective Date Drug Summary of Changes    Page(s) Updated
October 1, 2020 Levonorgestrel Drug added physician (2)

4. 2020 Immunization Updates: Vaccination during COVID-19, Flu, HepA, and Tdap

A new DUR Educational Article titled “2020 Immunization Updates: Vaccination during COVID-19, Flu, HepA, and Tdap (PDF format)” is available on the DUR: Educational Articles page of the Medi-Cal website.

5. Medi-Cal Rx Portal Registration Launched for Pharmacy Providers and Prescribers

The Department of Health Care Services (DHCS) continues to make significant towards a successful transition of pharmacy services on January 1, 2021 to Medi-Cal Rx.

To help facilitate a smooth and effective transition for Medi-Cal providers, beneficiaries, and other interested parties, DHCS has taken proactive steps to deploy a robust and multi-faceted outreach campaign, which includes, developing comprehensive beneficiary notices, developing call center scripts, conducting targeted provider outreach and providing for and advertising publicly various training opportunities available starting in October and continuing through the end of the year.

Additional activities include developing a dedicated Medi-Cal Rx website with secure portal components for Medi-Cal providers, health plans, beneficiaries and other interested parties.

Recently, DHCS launched the dedicated Medi-Cal Rx secure web portal, https://medi-calrx.dhcs.ca.gov/home/, and a registration page for Medi-Cal provider access, including but not limited to physician prescribers and pharmacies. This registration is the first step in the process for pharmacies and prescribers to use the Medi-Cal Rx secure web portal andits web-based tools for pharmacy services. For detailed registration and training instructions, access the Medi-Cal Rx Web Portal and Training Registration article located on the Pharmacy News Page (https://medi-calrx.dhcs.ca.gov/provider/pharmacy-news).

Access to the Medi-Cal Rx secure web portal will include key functions such as:

  • Web Claims Submission, Activities, and Inquiries

  • Beneficiary Eligibility Look Up

  • Prior Authorization Information and Submission

Other functions within the Web Portal include:

  • Learning Management System (LMS) for pharmacy and prescriber trainings

  • Message Center

  • Provider Survey

  • Password Management

  • Secure Chat

DHCS reminds Medi-Cal providers, health plans, beneficiaries and other interested parties that it is very important registration be completed early so user training and access are complete and active by January 1, 2021. Doing so will help to remove any potential challenges for successful utilization of the Medi-Cal Rx secure web portal.

The entire dedicated Medi-Cal Rx website will be fully operational by January 1, 2021. In the meantime, DHCS encourages Medi-Cal pharmacy providers and prescribers, health plans, beneficiaries, and other interested parties to sign up for the Medi-Cal Rx Subscription Service, which allows interested parties to receive Medi-Cal Rx updates in near real-time by email.

For general project questions and/or comments, please visit the DHCS website or email RxCarveOut@dhcs.ca.gov. In addition, DHCS encourages stakeholders to review the Medi-Cal Rx Frequently Asked Questions (FAQ) document, which continues to be updated as the project advances.

6. Notification of Billing Change for Pen Needles

Effective for dates of service on or after January 1, 2021, pen needles will no longer be reimbursable when billed on a CMS-1500 claim form using HCPCS code A4215 (needle, sterile, any size, each), submitted to the California Medicaid Management Information System (MMIS) Fiscal Intermediary (FI). Instead, pen needles, when used in conjunction with injection pens to deliver injectable medications, are to be billed on a pharmacy claim form using the contracted product’s National Drug Code.

This change only applies to pen needles. Medical supply benefits and billing policy for conventional, filter and safety sterile needles (excluding pen needles) will still be billed on a CMS-1500 claim form using HCPCS code A4215, product Universal Product Number (UPN), and UPN qualifier, for Medi-Cal fee-for-service beneficiaries.

For beneficiaries in Medi-Cal Managed Care Plans (MCPs), sterile needles (excluding pen needles) are not carved out from managed care to fee-for-service, therefore the beneficiary’s MCP is responsible for providing sterile needles (excluding pen needles) as a benefit.

As a reminder, as of January 1, 2021, Medi-Cal pharmacy claims will be processed by the new Medi-Cal pharmacy vendor.

Provider Manual(s) Page(s) Updated
Durable Medical Equipment
Pharmacy
mc sup (1, 2, 6)

7. Average Selling Price Update for Blood Factors

Effective for dates of service on or after October 1, 2020, Esperoct® is billable under HCPCS code J7204 (injection, Factor VIII, antihemophilic factor [recombinant], [Esperoct], glycopegylated-exei, per IU).

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
blood (3); non ph (15, 29)
Obstetrics
Rehabilitation Clinics
non ph (15, 29)
Chronic Dialysis Clinics
Pharmacy
blood (3)


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