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Medi-Cal Update

Pharmacy | October 2020 | Bulletin 978

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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
September 14, 2020 Pralsetinib Drug added, administration added drugs cdl p1c (54)
drugs cdl p4 (11)
November 1, 2020 Baloxavir Marboxil Drug added, administration added drugs cdl p1a (21)
drugs cdl p4 (7)
November 1, 2020 Cyproheptadine Drug added, administration added drugs cdl p1a (52)
drugs cdl p4 (13)
November 1, 2020 Mupirocin Drug added, administration added drugs cdl p1b (115)
drugs cdl p4 (5, 28)
November 1, 2020 Segesterone Acetate and Ethinyl Estradiol Drug added, administration added, restriction added drugs cdl p1d (3)
drugs cdl p4 (22)
November 1, 2020 Ubrogepant Drug added, administration added, restriction added drugs cdl p1d (44)
drugs cdl p4 (14)

Changed Drug(s)
Effective Date Drug Summary of Changes Page(s) Updated
November 1, 2020 Aspirin Dosage added, strength added drugs cdl p2 (3)
November 1, 2020 Cefdinir Restriction removed drugs cdl p1a (36)
November 1, 2020 Divalproex Sodium Restriction removed drugs cdl p1a (66)
November 1, 2020 Meloxicam Restriction removed, note removed drugs cdl p1b (96)
November 1, 2020 Nabumetone Restriction removed, note removed drugs cdl p1c (1)
November 1, 2020 Naproxen Restriction removed, note removed drugs cdl p1c (4)
November 1, 2020 Ondansetron Dosage added, strength added drugs cdl p1c (26)
November 1, 2020 Piroxicam Restriction removed, note removed drugs cdl p1c (49)
November 1, 2020 Salsalate Restriction removed drugs cdl p1d (1)
November 1, 2020 Sulindac Restriction removed, note removed drugs cdl p1d (15)
November 1, 2020 Tolmetin Restriction removed, note removed drugs cdl p1d (33)
December 1, 2020 Ezetimibe Restriction removed drugs cdl p1b (23)
December 1, 2020 Solifenacin Succinate Restriction removed drugs cdl p1d (9)

2. Drug Safety Communication: Stronger Warning Labels for Benzodiazepines

A new DUR Educational Article titled “Drug Safety Communication: Stronger Warning Labels for Benzodiazepines (PDF)” is available on the DUR: Educational Articles page of the Medi-Cal website.

3. Updates to the List of Medical Supplies Billing Codes, Units and Quantity Limits

Effective for dates of service on or after December 1, 2020, the enteral feeding supply codes in the List of Medical Supplies Billing Codes, Units and Quantity Limits is updated. The Maximum Allowable Product Cost (MAPC) is updated for the enteral feeding supply HCPCS codes with an established price on file, and no longer require enclosures to claims for documentation of product cost.

Description MAPC per Unit of Measure (UOM) UOM
Enteral feeding supply kit; syringe fed $3.0200 ea
Enteral feeding supply kit; pump fed $3.8500 ea
Enteral feeding supply kit; gravity fed $2.6600 ea
Nasogastric tubing with stylet $16.3700 ea
Nasogastric tubing without stylet $11.9900 ea
Stomach tube - levine type $1.8200 ea
Gastrostomy/jejunostomy tube, standard, any material, any type, each $74.3900 ea
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each $119.7900 ea
Extension set for enteral feeding $10.1300 ea

4. Medi-Cal Rx Payer Sheet Now Available

Effective January 1, 2021, Magellan Medicaid Administration, Inc. (Magellan) will be the new Medi-Cal Rx vendor. All administrative services related to Medi-Cal pharmacy benefits billed on pharmacy claims from the existing intermediaries, Medi-Cal Fee-for-Service (FFS) or Managed Care Plans (MCPs) will transition to Magellan.

Medi-Cal Rx Payer Sheet

In anticipation of this transition, the Payer Sheet is now available on the Medi-Cal Rx Web Portal in the Forms and Information Section. The payer sheet includes the claim submission fields and requirements to submit Medi-Cal pharmacy claims on or after January 1, 2021. The new Payer Sheet also includes updated contact information. Pharmacy providers and their billing agents can use this information to begin making changes to their processes and technical solutions.

5. Medi-Cal Rx and Prescribing Medi-Cal Providers

What is Medi-Cal Rx and when does the transition take place?
Medi-Cal Rx is the transition of all administrative services related to Medi-Cal pharmacy benefits billed on pharmacy claims from the existing intermediaries to the new Medi-Cal Rx vendor, Magellan Medicaid Administration, Inc. (MMA). Medi-Cal Rx goes into effect January 1, 2021, and will include all pharmacy services billed as a pharmacy claim, including but not limited to, outpatient drugs (prescription and over-the counter), Physician Administered Drugs (PADs), enteral nutrition products and some medical supplies.

How does the transition affect prescribers?
As a prescribing Medi-Cal Provider, registration in the Medi-Cal Rx portal will be required to access pharmacy services tools for Prior Authorizations, pharmacy claim submissions and status updates. The systems currently used to submit Prior Authorizations for prescriptions and pharmacy claim submission will change. As of January 1, 2021, Medi-Cal prescribers will use the secure Medi-Cal Rx Provider Portal to perform multiple functions related to the submission of PA requests, including, but not limited to, the following: PA submission, status inquires, cancellation and adding additional information or documents to “In Progress” requests. The Medi-Cal Rx transition will also include an updated Contract Drug List (CDL) that you will need to become familiar with.

What should I do?
Providers can start by visiting the new Medi-Cal Rx website to review general information about the transition and to access registration and training for the new Medi-Cal Rx Portal. The Medi-Cal Rx site serves as a platform to educate and communicate available resources, information and changes to interested parties. Educational content and frequently asked questions (FAQs) will be posted and updated regularly. Additionally, a Medi-Cal Rx Subscription Service Sign Up (MCRxSS) is available so interested parties can sign up and receive regular Medi-Cal Rx updates by email.

Next, become familiar with the CDL by visiting the Medi-Cal Rx FAQ page and clicking on the “Policy Considerations” link on the left side of the page. The current CDL can be viewed in the current Medi-Cal website under Provider Manuals. Starting on January 1, 2021, the CDL will be available on the Medi-Cal Rx website.

Lastly, enrolled Medi-Cal providers (including, but not limited to, pharmacies and prescribing physicians) will need to register to have access to a secure provider portal in addition to the public Medi-Cal Rx website. To register, click on the “Secured portal access” option on the top right of the homepage, choose “Provider Portal” and then click on the “Register” icon.

Once the registration process is completed, secure access is available via the Medi-Cal Rx site and on January 1, 2021, will include the following functionalities:

  • Beneficiary Eligibility Lookup

  • Web Claims Submission

  • Prior Authorization Submission and Inquiry

  • Learning Management System

  • Secure Message Center

  • Secure Chat

What if I am not an enrolled Medi-Cal Provider?
Only enrolled Medi-Cal Providers can register and have access to the various tools and resources available in the Medi-Cal Rx secure portal on January 1, 2021. Ordering, Referring and Prescribing (ORP) providers not yet enrolled as a Medi-Cal provider in the DHCS Provider Application and Validation for Enrollment (PAVE) system, are encouraged to enroll.

ORP providers can enroll via the DHCS PAVE system on the Provider Application and Validation for Enrollment. ORP providers can learn more about ORP resources on the Ordering, Referring and Prescribing (ORP) page. Providers should note that ORP enrollment has a shorter enrollment cycle than other provider enrollment cycles (e.g., Pharmacies). 

The Department of Health Care Services (DHCS) strongly encourages the Medi-Cal prescriber community to closely monitor upcoming Medi-Cal Rx bulletins for additional information regarding any future updates.

6. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:



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