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Medi-Cal Update

Pharmacy | April 2021 | Bulletin 990

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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 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
January 1, 2021 Saquinavir Mesylate Dosage removed drugs cdl p1d (1)
March 1, 2021 Enzalutamide Strength added, size added drugs cdl p1b (9)
May 1, 2021 Miconazole Nitrate Strength removed drugs cdl p2 (11)
May 1, 2021 Travoprost Restriction added drugs cdl p1d (38)

2. Potential Increased Arrhythmia Risk from Lamotrigine

A new DUR Educational Article titled “Drug Safety Communication: Potential Increased Arrhythmia Risk from Lamotrigine (PDF)” is available on the DUR: Educational Articles page of the Medi-Cal website.

3. Updates to The List of Enteral Nutrition Products

Effective for dates of service on or after March 1, 2021, the following changes apply to the List of Enteral Nutrition Products.

  • Ketovie 3:1 Medi-Cal Billing Code was updated to 24359050403 (Aijnomoto Cambrooke, Inc.)

  • EquaCare Jr, Medi-Cal Billing Code 24359081108, the UPC Number per Case was updated to 324359811101 (Aijnomoto Cambrooke, Inc.)

  • Glytactin Build products, Medi-Cal Billing Codes 24359035307 and 24359053101, package sizes were updated to 15g packets and 30g packets, respectively (Aijnomoto Cambrooke, Inc.)

  • Peptamen Intense VHP products, Medi-Cal Billing Codes 43900072395 and 43900073049, the product-specific criteria was removed (Nestlé HealthCare Nutrition)
Note:

Listing of a product is not a guarantee of its availability. The product number approved on an authorization must be the same product number dispensed to the beneficiary and claimed for reimbursement by the provider.

The amount reimbursed to providers for enteral nutrition products shall not exceed the published estimated acquisition cost (EAC) plus a 23 percent markup. Medi-Cal beneficiaries denied enteral nutrition products who believe the denial was in error may ask for a state hearing by contacting the California Department of Social Services at 1-800-743-8525 or 1-855-795-0634 or by sending a written request to:

California Department of Social Services
State Hearings Division
MS 9-17-37
P.O. Box 944243
Sacramento, CA   94244-2430

Provider Manual(s) Page(s) Updated
Allied Health
Durable Medical Equipment and Medical Supplies
Pharmacy
enteral (1)

4. Correction to MAPC Per UOM for HCPCS Code A4657 in Medical Supplies Billing Codes, Units and Quantity Limits Spreadsheet

The MAPC per Unit of Measure for HCPCS code A4657 in The Medical Supplies Billing Codes, Units and Quantity Limits spreadsheet has been corrected to ‘By Report’.



Note:
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