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Medi-Cal Update

Pharmacy | May 2021 | Bulletin 992

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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
April 1, 2021 Margetuximab-cmkb Drug added,
administration added,
restriction added
drugs cdl p1b (95),
drugs cdl p4 (11)
April 1, 2021 Sacituzumab Govitecan-hziy Drug added,
administration added,
restriction added
drugs cdl p1d (1),
drugs cdl p4 (12)

Effective Date Drug Summary of Changes Page(s) Updated
June 1, 2021 Morphine Sulfate Restriction removed,
restriction changed,
restriction added
drugs cdl p1b (113, 114)
June 1, 2021 Potassium Bicarbonate/Citric Acid Restriction removed drugs cdl p1c (52)
June 1, 2021 Potassium Chloride Restriction removed drugs cdl p1c (53)
August 1, 2021 Palonosetron hcl Restriction changed drugs cdl p1c (31)

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 April 1, 2021
NDC Labeler Code Contracting Company's Name
74527 Macrogenics, Inc.
Additions, effective October 1, 2016
NDC Labeler Code Contracting Company's Name
70121 Amneal Pharmaceuticals, LLC

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 (18, 22)

3. Updates to the List of Enteral Nutrition Products

Effective for dates of service on or after July 1, 2021, the Department of Health Care Services (DHCS) has updated the List of Enteral Nutrition Products. Providers may refer to the List of Enteral Nutrition Products in the List of Enteral Nutrition Products section of the appropriate Part 2 provider manual.

The manufacturers guarantee that Medi-Cal providers may purchase, upon request, the listed products at or below the maximum acquisition cost (MAC) for dispensing with an approved Treatment Authorization Request (TAR) or a Service Authorization Request (SAR) through the Medi-Cal fee-for-service pharmacy delivery system. Providers can locate MAC price suppliers by calling manufacturer phone numbers listed in the List of Enteral Nutrition Products.

Beneficiaries affected by changes to the list, should seek new prescriptions from their licensed prescriber, and new authorizations from their pharmacy provider for a comparable product on the list. Continuing care does not apply.

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
P.O. Box 944243, MS 9-17-37
Sacramento, CA   94244-2430
Provider Manual(s) Page(s) Updated
Durable Medical Equipment
Pharmacy
enteral (1, 3)

4. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:



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