Medi-Cal Logo

Medi-Cal Update

Pharmacy | June 2021 | Bulletin 994

Print Medi-Cal Update Print Icon

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
February 27, 2021    Janssen Coronavirus Disease 2019 (COVID-19) Vaccine Drug added,
administration added,
restriction added   
drugs cdl p1a (73)
April 1, 2021    Umbralisib Drug added,
administration added,
restriction added   
drugs cdl p1d (44),
drugs cdl p4 (12)
April 5, 2021 Melphalan Flufenamide Drug added,
administration added,
restriction added
drugs cdl p1b (97),
drugs cdl p4 (11)
April 13, 2021    Tivozanib Drug added,
administration added,
restriction added   
drugs cdl p1d (32),
drugs cdl p4 (12)
July 1, 2021 Apremilast Drug added,
administration added,
restriction added
drugs cdl p1a (22),
drugs cdl p4 (32)
July 1, 2021    Dostarlimab-gxly Drug added,
administration added,
restriction added   
drugs cdl p1a (97),
drugs cdl p4 (10)
July 1, 2021 Elagolix Drug added,
administration added,
restriction added
drugs cdl p1b (2),
drugs cdl p4 (23)
July 1, 2021    Elagolix,
Estradiol,
and Norethindrone Acetate
Drug added,
administration added,
restriction added   
drugs cdl p1b (2),
drugs cdl p4 (23)
July 1, 2021 Etanercept Drug added,
administration added,
restriction added
drugs cdl p1b (19),
drugs cdl p4 (32)
July 1, 2021    Evolocumab Drug added,
administration added,
restriction added   
drugs cdl p1b (23),
drugs cdl p4 (30)
July 1, 2021 Fremanezumab-vfrm Drug added,
administration added,
restriction added
drugs cdl p1b (38),
drugs cdl p4 (14)
July 1, 2021    Lactic Acid,
Citric Acid,
and Potassium Bitartrate
Drug added,
administration added,
restriction added   
drugs cdl p1b (75),
drugs cdl p4 (22)
July 1, 2021 Perampanel Drug added,
administration added,
restriction added
drugs cdl p1c (42),
drugs cdl p4 (17)
July 1, 2021    Tepotinib Drug added,
administration added,
restriction added   
drugs cdl p1d (21),
drugs cdl p4 (12)
Effective Date Drug Summary of Changes Page(s) Updated
February 1, 2021    Semaglutide Strength added,
size added   
drugs cdl p1d (4)
July 1, 2021    Pralsetinib Restriction changed drugs cdl p1c (54)
May 10, 2021    Pfizer-BioNtech COVID-19 Vaccine    Restriction changed drugs cdl p1a (73)

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 5, 2021
NDC Labeler Code      Contracting Company's Name
73657 Oncopeptides, Inc.
   
Additions, effective April 13, 2021
NDC Labeler Code      Contracting Company's Name
45629 AVEO Pharmaceuticals, Inc
   
Additions, effective July 1, 2021
NDC Labeler Code      Contracting Company's Name
72888Advagen Pharma Ltd
73462G1 Therapeutics Inc
73153Juno Therapeutics, Inc.
73336Urovant Sciences, Inc.
69528Metacel Pharmaceuticals
71511Athena Bioscience LLC
73562Nestle Healthcare Nutrition, Inc.
73129Origin Biosciences, Inc.
73604Kiniksa Pharmaceuticals (UK), Ltd.
80056Intra-Sana Laboratories, LLC
80705Tripoint Therapeutics
80644Zealand Pharma A/S
79952ADC Therapeutics America, Inc.
76478Oak Pharmaceuticals, Inc
   
Terminations, effective July 1, 2021
NDC Labeler Code      Contracting Company's Name
71351Brookfield Pharmaceuticals, LLC
36800Topco Associates LLC
53270Cangene Bio Pharma
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 (7, 8, 11, 16, 17, 19–24)

3. Updates to the List of Enteral Nutrition Products

Recently, the Department of Health Care Services (DHCS) updated the List of Enteral Nutrition Products with changes effective July 1, 2021.

Please note that the Maximum Acquisition Cost (MAC) and Estimated Acquisition Cost (EAC) pricing for Abbott Nutrition’s Ensure Harvest product and Nestlé HealthCare Nutrition’s four Compleat Organic Blends products were listed incorrectly. The correct MAC and EAC pricing, effective July 1, 2021, is as follows:


Manufacturer Product Label Name Medi-Cal Billing Code (NDC like number) MAC per gm or ml EAC per gm or ml
Abbott Nutrition Ensure Harvest 8oz Recloseable Carton 70074067965 0.0145 0.0161
Nestlé HealthCare Nutrition Compleat Pediatric Organic Blends – Chicken-Garden Blend, 24 x 10.1oz (300mL) pouch 43900084642 0.0131 0.0147
Nestlé HealthCare Nutrition Compleat Pediatric Organic Blends – Plant Based, 24 x 10.1oz (300mL) pouch 43900011721 0.0131 0.0147
Nestlé HealthCare Nutrition Compleat Organic Blends – Chicken-Garden Blend, 24 x 10.1oz (300mL) pouch 43900047993 0.0153 0.0169
Nestlé HealthCare Nutrition Compleat Organic Blends – Plant Based, 24 x 10.1oz (300mL) pouch 43900019270 0.0153 0.0169

For dispensing to eligible Medi-Cal fee-for-service outpatient beneficiaries, the contractors have guaranteed that Medi-Cal providers may purchase, upon request, the products at or below the MAC with an approved Treatment Authorization Request (TAR) or a Service Authorization Request (SAR). Providers can locate MAC price suppliers by calling manufacturer phone numbers referenced in the List of Enteral Nutrition Products.

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

4. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:



Note:
Download PDF (Portable Document Format) reader from the Web Tool Box.