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Medi-Cal Update

Pharmacy | November 2020 | Bulletin 980

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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.

Effective Date Drug Summary of Changes Page(s) Updated
October 1, 2020 BELANTAMAB MAFODOTIN-BLMF Drug added, administration added, restriction added drugs cdl p1a (33)
October 1, 2020 BLINATUMOMAB Drug added, administration added, restriction added drugs cdl p1a (38)
October 1, 2020 CARFILZOMIB Drug added, administration added, restriction added drugs cdl p1a (51)
October 1, 2020 RIPRETINIB Drug added, administration added, restriction added drugs cdl p1c (74)
October 1, 2020 TALIMOGENE LAHERPAREPVEC Drug added, administration added, restriction added drugs cdl p1d (17)
December 1, 2020 CHLORDIAZEPOXIDE HCL Drug added, administration added, restriction added drugs cdl p1a (58)
Effective Date Drug Summary of Changes Page(s) Updated
October 1, 2020 METHOTREXATE Restriction changed drugs cdl p1b (103)
October 1, 2020 PANITUMUMAB Restriction changed drugs cdl p1c (32)
December 1, 2020 ACYCLOVIR Restriction removed drugs cdl p1a (5)
December 1, 2020 CLONAZEPAM Restriction changed drugs cdl p1a (68)
December 1, 2020 DIAZEPAM Restriction removed, restriction radded drugs cdl p1a (62)
December 1, 2020 FLURAZEPAM Restriction added drugs cdl p1b (33)
December 1, 2020 LATANOPROST Restriction removed drugs cdl p1b (78)
December 1, 2020 LORAZEPAM Restriction changed drugs cdl p1b (91)
December 1, 2020 RAMELTEON Restriction changed drugs cdl p1c (68)
December 1, 2020 TEMAZEPAM Restriction added drugs cdl p1d (19)
December 1, 2020 TRIAZOLAM Restriction added drugs cdl p1d (40)
December 1, 2020 VALACYCLOVIR HCL Restriction removed drugs cdl p1d (45)
December 1, 2020 ZOLPIDEM TARTRATE Restriction added drugs cdl p1d (56)

2. Medi-Cal Rx Electronic Claims Submission

Effective April 1, 2021, Magellan Medicaid Administration, Inc. (Magellan) will provide administrative supports and services for Medi-Cal fee-for-service (FFS) pharmacy benefits, collectively referred to as “Medi-Cal Rx.” Medi-Cal Rx will include all pharmacy benefits billed by pharmacy providers on pharmacy claims, for Medi-Cal beneficiaries in both the Medi-Cal FFS and managed care delivery systems.

Under the existing processes in Medi-Cal, Medi-Cal providers choosing to submit claims electronically to the Medi-Cal FFS Fiscal Intermediary (FI) must complete and submit the DHCS 6153 form, titled Medi-Cal Telecommunications Provider And Biller Application/Agreement. The DHCS 6153 form indicates that Medi-Cal providers will be provided with a unique Medi-Cal Submitter Identification (ID) and password, which is used for claims certification purposes, accuracy and correction of claims or payments and more.

In order to reduce the burden on our existing Medi-Cal pharmacy providers and ease the transition to Medi-Cal Rx, as well as to comply with the Governor’s January 1, 2019 Executive Order N-01-2019, the Department of Health Care Services (DHCS) will use the existing DHCS 6153 forms already on file for Medi-Cal pharmacy providers and billers for Medi-Cal Rx electronic claims submission purposes as of April 1, 2021. For Medi-Cal Rx electronic claims submissions, Medi-Cal pharmacy providers will be provided with unique Medi-Cal Rx credentials, which are different than the Medi-Cal Submitter ID and password used for the existing Medi-Cal FFS FI. Providers should note that use of the unique Medi-Cal Rx credentials constitute acceptance of all of the terms and conditions outlined in the existing DHCS 6153 form.

While DHCS recognizes that the DHCS 6153 form currently only references the current Medi-Cal FFS FI, please also note DHCS is in the process of amending the DHCS 6153 form, or create a new form, to specifically reference Magellan and Medi-Cal Rx, inclusive of all related processes and procedures. DHCS aims to release this revised form via Provider Bulletin no later than May 1, 2021. At that time, the Medi-Cal pharmacy provider/biller will need to return the revised DHCS 6153 (or a new) form, within the specified timeframe, to ensure an up-to-date Medi-Cal Rx inclusive agreement is on file.

Until such time, the provider/biller agrees that using the Medi-Cal Rx credentials when submitting an electronic claim will identify the submitter and shall serve as acceptance to the terms and conditions of DHCS’s form DHCS 6153. The provider/biller further acknowledges the necessity of maintaining the privacy of the Medi-Cal Rx credentials and agrees to bear full responsibility for use or misuse of the Medi-Cal Rx credentials, should privacy not be maintained.

If Medi-Cal pharmacy providers/billers have questions regarding this bulletin, please direct all such communications to MediCalRxEducationOutreach@magellanhealth.com.

3. Updates to List of Contracted Tracheostomy Supplies

Effective for dates of service on or after December 1, 2020, the List of Contracted Tracheostomy Supplies is updated. Several products that meet the description of contracted HCPCS billing codes A7520 (Tracheostomy/laryngectomy tube, noncuffed, polyvinyl chloride (PVC), silicone or equal, each) and A7521 (Tracheostomy/laryngectomy tube, cuffed, polyvinyl chloride (PVC), silicone or equal, each) have been added.

4. Medi-Cal Rx Payer Sheet Now Available

Effective April 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 April 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. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:



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