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Medi-Cal Update

Pharmacy | February 2021 | Bulletin 986

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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
March 1, 2021    Bumetanide Drug added,
administration added   
drugs cdl p1a (43),
drugs cdl p4 (20)
March 1, 2021 Diclofenac Sodium Drug added,
administration added
drugs cdl p1a (90),
drugs cdl p4 (28)
March 1, 2021 Flecainide Acetate Drug added,
administration added
drugs cdl p1b (28),
drugs cdl p4 (20)
March 1, 2021    Levalbuterol Drug added drugs cdl p4 (12)
March 1, 2021 Lidocaine Drug added,
administration added
drugs cdl p1b (86),
drugs cdl p4 (28)
March 1, 2021 Sildenafil Citrate Drug added,
administration added,
restriction added
drugs cdl p1d (4),
drugs cdl p4 (19)
March 1, 2021 Tretinoin    Drug added,
administration added
drugs cdl p1d (38),
drugs cdl p4 (28)
Effective Date Drug Summary of Changes    Page(s) Updated
January 1, 2021    Ceritinib Drug added drugs cdl p1a (56)
March 1, 2021    Colesevelam HCL Restriction updated drugs cdl p1a (72)
March 1, 2021    Levalbuterol HCL Restriction removed drugs cdl p1b (81)
March 1, 2021    Levalbuterol Tartrate Restriction removed drugs cdl p1b (82)
March 1, 2021    Tamoxifen Citrate Restriction removed drugs cdl p1d (17)
April 1, 2021    Pramipexole Dihydrochloride Restriction updated drugs cdl p1c (55)

2. Update to the List of Contracted Incontinence Creams and Washes

Effective for dates of service on or after April 1, 2021, TENA Cleansing Cream is added as a contracted wash product for Essity HMS North American, Inc. on the List of Contracted Incontinence Creams and Washes.

3. Recommencement of Pharmacy Retroactive Claim Adjustments Remains Paused

The Department of Health Care Services (DHCS) will not resume retroactive pharmacy claim adjustments beginning with the February 11, 2021, warrant date. Recommencement of retroactive pharmacy claim adjustments due to a change in the reimbursement methodology for covered outpatient drugs will continue to be paused until further notice. This pause will apply to all pharmacy claims billed through the Medi-Cal fee-for-service Fiscal Intermediary and includes those claims that were also subject to an alternative payment arrangement.

4. Pharmacy Provider Self-Attestation Process Changes in 2021

Although currently delayed, Medi-Cal pharmacy benefits will eventually be transitioned to and thereafter administered through the fee-for-service delivery system for all Medi-Cal beneficiaries (generally referred to as “Medi-Cal Rx”). The Department of Health Care Services (DHCS) has partnered with Magellan Medicaid Administration, Inc. (Magellan) to provide a wide variety of administrative services and support for Medi-Cal Rx.

Magellan has contracted with Mercer Government Human Services Consulting (Mercer), part of Mercer Health and Benefits, LLC, to administer the annual pharmacy provider self-attestation survey for professional dispensing fee reimbursement. The objective of the next self-attestation survey is to assign professional dispensing fee rates for Medi-Cal enrolled pharmacies beginning July 1, 2021 and ending June 30, 2022.

Despite the current delay to transition Medi-Cal pharmacy benefits and administrative services to Medi-Cal Rx, DHCS, through Mercer, will be initiating the provider self-attestation process in April 2021 for the 2020 calendar year reporting period for those pharmacy providers seeking the higher of two professional dispensing fee rates determined by annual prescription volume. Key changes to the self-attestation process include:

  • The provider self-attestation process for the calendar year 2020 reporting period will begin in April 2021 (in previous years, the survey period was January 15 through the end of February).

  • Mercer, on behalf of Magellan and DHCS, will administer the provider self-attestation survey with options for online submission or an email submission of a Microsoft Excel® formatted template.

  • In addition to the standard online submission, pharmacies will have an additional survey submission option that will allow a bulk submission for multiple locations. The new template will allow a corporate office for chain-affiliated stores under common ownership to submit multiple stores in one self-attestation survey file.

As was done previously, newly approved fee-for-service pharmacy providers that are notified of their enrollment approval after the attestation period closes will receive the higher dispensing fee. However, those same providers will have to attest for subsequent reporting periods in order to continue to be eligible for the higher dispensing fee in subsequent fiscal years.

Provider Webinar Details

A virtual stakeholder information session will be held from 1 p.m. to 5 p.m. on March 25, 2021, to review the new self-attestation survey process and project timeline.

In the meantime, pharmacy providers may refer to the updated Pharmacy Provider Self-Attestation FAQs for more information.

DHCS reminds the Medi-Cal pharmacy fee-for-service provider community to closely monitor upcoming Medi-Cal pharmacy bulletins for additional information regarding future updates, by signing up via the Medi-Cal Rx Subscription Service.

For updates on Medi-Cal Rx, please visit the Department’s dedicated websites at Medi-Cal Rx and the DHCS Medi-Cal Rx Transition website. 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.

5. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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