The Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal.  

• Update: Deferral Response Method via Medi-Cal Rx Provider Portal (December 8) 
• Medi-Cal Rx Weekly Wrap-up for December 1-7 (December 8) 
• Reinstatement Spotlight (December 8) 
• Activation of Reject Code 16 – Medi-Cal Rx Program Integrity Update (December 5) 

Also in California, the Department of Health Care Services posted the following:  

• Family Mosaic Project is No Longer a Medi-Cal Managed Care Plan in San Francisco County, effective for dates of service on or after January 1, 2024 
• Billing Update for COVID-19 Oral Medication Paxlovid 
• Forthcoming Contracted Incontinence Supplies Program Updates 
• Novavax COVID-19 Vaccine Authorization 

Also in California, the Board of Pharmacy proposed modifications to the following. To view all documents associated with these proposed regulatory actions and other pending regulations, visit the board’s “Pending Regulations” webpage.  

• Designation of Pharmacist-in-Charge 

• Notice of Proposed Action 
• Initial Statement of Reasons 
• Proposed Text 
• 45-Day Comment Period: November 17, 2023-January 2, 2024 

• Temporary License for Military Spouses 

• Notice of Modified Text 

• Modified Text 
• 15-Day Comment Period: December 13, 2023-December 28, 2023 

• Notice to Consumers 

• Notice of Modified Text 
• Modified Text 
• 15-Day Comment Period: December 13, 2023-December 28, 2023 

Also in California, Gov. Gavin Newsom (D) appointed Sarah Brooks, as Chief Deputy Director of Health Care Programs at the Department of Health Care Services. Given the capacity to manage program growth and increased complexity of the programs, moving forward, the Chief Deputy Director for Health Care Programs and State Medicaid Director will be two separate roles. The Chief Deputy Director for Health Care Programs will focus on internal program implementation and operations in California’s health care programs, whereas the State Medicaid Director will focus on Medi-Cal policy development and relationships with its external partners, including the federal Centers for Medicare & Medicaid Services (CMS). Recruitment efforts are ongoing for a State Medicaid Director. 

Finally in California, Gov. Gavin Newsom (D) announced the launch of a new tool to continue the state’s efforts to fight the ongoing opioid crisis – a comprehensive website with resources for Californians: Opioids.CA.GOV. This website serves as a reliable source of information on prevention, data, treatment and support. Also, Californians can access information related to the state’s use of opioid settlement funds and efforts to hold drug-traffickers accountable.  

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

The Department of Health Care Services (DHCS) posted the following alerts, weekly notices, and monthly bulletin on the Medi-Cal Rx Web Portal. Please note the “Maximum Allowable Ingredient Cost 30-Day Pharmacy Provider Notice”; rates will be effective January 1, 2024, and will be posted to the Mercer Med-Cal Rx website no later than December 1, 2023. Also note the “Commercial COVID-19 Vaccine Coverage for Children” alert providing an updated policy whereby COVID-19 vaccines are a Medi-Cal Rx pharmacy benefit for members three years of age and older.

• Medi-Cal Rx Weekly Wrap-up for November 17-30 (December 1)
• Reinstatement Spotlight (December 1)
• 30-day Countdown: Medi-Cal Managed Care Plan Transition (December 1)
• Maximum Allowable Ingredient Cost 30-day Pharmacy Provider Notice (December 1)
• Medical Supplies Updates: Updates to Contracted Pen Needles, Insulin Syringes, and Sterile Syringes with Needles (Non-Insulin), Effective January 1, 2024 (December 1)
• Medical Supplies Update: Updates to Diabetic Testing Supplies, Effective January 1, 2024 (December 1)
• Medical Supplies Update: Updates to List of Contracted Self-Monitoring Blood Glucose Systems (Glucometers), Control Solutions, and Lancing Devices, Effective January 1, 2024 (December 1)
• Updates to the List of Contracted Enteral Nutrition Products, Effective January 1, 2024 (December 1)
• Medi-Cal Rx Monthly Bulletin for December (December 1)
• Changes to the Medi-Cal Rx Contract Drugs List (December 1)
• Updates to the Medi-Cal Rx Provider Manual (December 1)
• Commercial COVID-19 Vaccine Coverage for Children (November 29)
• Paper Remittance Advice: Dollar Sign Placement Update (November 22)
• Reinstatement Spotlight (November 17)

Also in California, the Board of Pharmacy provided this important alert and reminder to licensees about the drug xylazine.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

The Department of Health Care Services (DHCS) posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal.  

• Medi-Cal Rx Weekly Wrap-up for November 3-9 (November 10) 
• Reinstatement Spotlight (November 10) 
• Enteral Nutrition Updates to the List of Contracted Enteral Nutrition Products, Effective November 1, 2023 (November 8) 
• November Provider Payment Release Date Change (November 8) 
• Reminder: Reinstatement of Brand Medically Necessary Prior Authorization Request Requirements for DAW (Dispense as Written) 1 Claims (November 8) 
• Deactivation of Override Code “55555” for Select Drug/Products – Medi-Cal Rx Program Integrity Update (November 3) 
• Medi-Cal Rx Weekly Wrap-up for October 27-November 2 (November 3) 
• Reinstatement Spotlight (November 3)   

Also in California, the DHCS (Department of Health Care Services) also posted the following: 

• November 2023 Durable Medical Equipment and Medical Supplies Medi-Cal Update Bulletin 
• November 2023 Pharmacy Medi-Cal Update Bulletin 
• Medi-Cal News: Ages 26 through 49 Adult Full Scope Medi-Cal Expansion 

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

The Department of Health Care Services (DHCS) posted the following alerts and monthly bulletin on the Medi-Cal Rx Web Portal.  

• 30-Day Countdown: Changes to Continuous Glucose Monitoring Systems Coverage Criteria and Prior Authorization Bundling (November 1) 
• Policy Update: Use of “Inner” and “Outer” NDCs for Claim Submission (November 1) 
• How to Resolve Reject Code A6 for Orally Administered Enteral Nutrition Claims (November 1)
• Medi-Cal Rx Monthly Bulletin for November (November 1) 
• Changes to the Medi-Cal Rx Contract Drugs List (November 1) 
• Changes to the Medi-Cal Rx Contract Drugs List – Over-the-Counter Drugs and Cough/Cold Preparations (November 1) 
• Changes to the Medi-Cal Rx Pharmacy Reimbursable Physician Administered Drugs (November 1) 
• Updates to the Medi-Cal Rx Provider Manual (November 1)
• Updates to Medi-Cal Rx Web Portal Appearance and Resources (October 29) 
• Medi-Cal Rx Weekly Wrap-up for October 20-26 (October 27) 
• Reinstatement Spotlight (October 27) 

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

The Board of Pharmacy posted the agenda and meeting materials for its November 1-2 Board Meeting. Please note the committee reports, particularly Enforcement & Compounding with respect to legislation recently signed by Gov. Gavin Newsom (D) and the Licensing Committee meeting items, e.g., remote processing, ratio, CLIA-waived tests, and central fill pharmacies. 

Also in California, the Department of Health Care Services (DHCS) posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal. Please note the alert about the quantity limit restrictions for certain continuous glucose monitoring devices. 

• Reminder: Reject Code 76 Point-of-Sale Messaging (October 25) 
• Reminder: Quantity Limit Restrictions for Common Continuous Glucose Monitoring Devices (October 24)
• Medi-Cal Rx Provider Prior Authorization Submission Processing – System Issue Resolved (October 23) 
• Medi-Cal Rx Weekly Wrap-up for October 13-19 (October 20) 
• Reinstatement Spotlight (October 20) 

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

Gov. Gavin Newsom (D) signed two bills, supported by NACDS, including AB (Assembly Bill) 1341 (Chapter 276, Statutes of 2023), legislation permitting pharmacists to provide COVID-19 medication as well as offer broader options for substance use disorder treatments as specified in the bill, and AB 317 (Chapter 322, Statutes of 2023), legislation helping to support patient access to essential healthcare services provided by pharmacists by requiring healthcare service plans that cover care that is otherwise within pharmacists’ scope of practice to reimbursement pharmacy providers for delivering those services. 

Also in California, Gov. Gavin Newsom (D) signed SB (Senate Bill) 786 (Chapter 414, Statues of 2023), legislation related to 340B, prohibiting PBMs from discriminating against a covered entity or its pharmacy in connection with dispensing a drug subject to federal pricing requirements or prevent a covered entity from retaining the benefit of discounted drug pricing for those drugs. 

Also in California, Gov. Gavin Newsom (D) signed AB 1286 (Chapter 470, Statutes of 2023), legislation sponsored by the Board of Pharmacy and opposed by NACDS and for which we urged him to veto because the legislation that would impose arbitrary staffing limits and impede pharmacies’ ability to optimize the use of pharmacy technicians to assist with technical duties that do not require a pharmacist’s professional judgement. This bill authorizes a pharmacy technician under the direct supervision and control of a pharmacist to prepare and administer influenza and COVID-19 vaccines, prepare, and administer epinephrine, perform specimen collection for specified tests, receive prescription transfers and accept clarification on prescriptions. The bill would prohibit a pharmacy with only one pharmacist from having more than one pharmacy technician performing these additionally authorized tasks unless the pharmacy has scheduled another pharmacy technician to assist the pharmacist with performing the nondiscretionary tasks currently authorized under existing law.  

Among the other provisions, the bill requires a pharmacist-in-charge or pharmacist on duty to immediately notify store management of any conditions that present an immediate risk of death, illness or irreparable harm to patients, personnel or pharmacy staff and requires store management to take immediate and reasonable steps to address and resolve those conditions. If those conditions are not resolved within 24 hours, it requires the pharmacist-in-charge or pharmacist on duty to notify the Board of Pharmacy. The board’s executive officer may choose to issue a cease-and-desist order, upon a reasonable belief that conditions within a pharmacy exist that present an immediate risk of death, illness or irreparable harm to patients, personnel, or pharmacy staff. Also in the bill, a chain community pharmacy, having 75 or more stores in California under the same ownership, must always be staffed with at least one clerk or pharmacy technician fully dedicated to performing pharmacy-related services with defined exceptions. Additionally, the bill requires a licensed community pharmacy to report all medication errors to an entity approved by the board.  

Also in California, Gov. Gavin Newsom (D) vetoed AB 782, legislation that would have excluded reconstitution of a drug pursuant to a manufacturer’s directions, tablet splitting or crushing, capsule opening or the addition of a flavoring agent from the Pharmacy Law’s definition of compounding. 

Also in California, on October 16, the Board of Pharmacy released the following message: 

Today this the start of National Pharmacy week, and the California State Board of Pharmacy would like to take this time to thank all pharmacy personnel for your hard work and professionalism to your patients. 

Each job plays an important part in providing the highest quality of care. According to recent statistics, more than 90% of Americans live within five miles of a community pharmacy, making your care accessible to millions of people. 

Thank you for your commitment to patient care and safety. 

Thank you! 

Also in California, the Department of Health Care Services (DHCS) posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal. Please note the postponed implementation date for Reject Code 80; see alert for details. DHCS (Department of Health Care Services) anticipates Reject Code 80 will be reinstated before the end of 2023. They have initiated efforts to more precisely communicate the diagnosis requirements that will be reinstated and will provide a 30-day notice prior to this reinstatement. Also, as a reminder, on November 10, Medi-Cal Rx will proceed with the reinstatement of the Enteral Nutrition transition policy for members ages 22 years and older and the Brand Medically Necessary (BMN) PA (prior authorization) requirements will also be reinstated on November 10. 

• Reject Code 80 (Diagnosis) – Implementation Date Postponed (October 17) 
• Medi-Cal Rx Weekly Wrap-up for October 6-12 (October 13)
• Reinstatement Spotlight (October 13) 
• 30-day Countdown: Phase IV, Lift 4: End of Transition Policy (October 10) 
• Effective October 13, 2023, Medi-Cal Rx Will Reinstate Quantity Restriction Edits (October 6) 
• Medi-Cal Rx Weekly Wrap-up for September 29-October 5 (October 6) 
• Reinstatement Spotlight (October 6) 

Finally in California, Medi-Cal posted the following: 

• 2023 HCPCS Quarter 4 Update 
• EFT Security Updates for Provider Change Requests 
• 2024 Managed Care Plan Transition 
• October 2023 Pharmacy Medi-Cal Update Bulletin 
• October 2023 Durable Medical Equipment and Medical Supplies Medi-Cal Update Bulletin 
• 2023-2024 Commercialized COVID-19 Vaccines Medi-Cal Policy Update 
• Implementation Delay for 2023 HCPCS Quarter 4 Update 
• 2024 ICD-10-CM/PCS Codes Update 

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

The Department of Health Care Services (DHCS) posted the following alerts and monthly bulleting on the Medi-Cal Rx Web Portal:

• Diabetic Supplies: Updates to the Quantity and Fill Limitations for Diabetic Testing Supplies (October 5)
• Updates to Enteral Nutrition Prescription Requirements (October 4)
• 90-Day Countdown: Medi-Cal Managed Care Plan Transition (October 3)
• Respiratory Syncytial Virus (RSV) Vaccines Arexvy^TM and Abrysvo^TM Now on the Contract Drugs List (October 3)
• How to Resolve Reject Code 76 – Plan Limitations Exceeded (October 2)
• COVID-19 Antigen Over-the-Counter Test Coverage Updates, Effective November 1, 2023 (October 1)
• Medical Supplies: Future Changes to Continuous Glucose Monitoring Systems Coverage Criteria and Prior Authorization Bundling (October 1)
• Diabetic Supplies: Updates to the Dexcom G7® Continuous Glucose Monitoring Sensor Package Size Description, Effective October 1, 2023 (October 1)
• Medi-Cal Rx Monthly Bulletin for October (October 1)
• Changes to the Medi-Cal Rx Contract Drugs List (October 1)
• Changes to Medi-Cal Rx Contract Drugs List – Authorized Drug Manufacturer Labeler Codes (October 1)
• Changes to Medi-Cal Rx Pharmacy Reimbursable Physician Administered Drugs (October 1)
• Updates to the Medi-Cal Rx Provider Manual (October 1)
• Medi-Cal Rx Weekly Wrap-up for September 22-28 (September 29)
• Reinstatement Spotlight (September 29)
• Update: Reimbursement for New Commercial COVID-19 Vaccines (September 22).

Also in California, NACDS submitted a letter of support to Gov. Gavin Newsom (D) urging him to sign AB 1341. The governor subsequently signed AB 1341 (Chapter 276, Statutes of 2023) on September 30. The newly bill enacted permits pharmacists to provide COVID-19 medication as well as offer broader options of substance use disorder treatments as specified in the bill.

Also in California, NACDS submitted a letter to Gov. Gavin Newsom (D) urging him to veto AB 1286, legislation that would impose arbitrary staffing limits and impede pharmacies’ ability to optimize the use of pharmacy technicians to assist with technical duties that do not require a pharmacist’s professional judgement.

Finally in California, NACDS submitted a letter of support to Gov. Gavin Newsom (D) urging him to sign AB 317, legislation helping to support patient access to essential healthcare services provided by pharmacists by requiring healthcare service plans that cover care that is otherwise within pharmacists’ scope of practice to reimbursement pharmacy providers for delivering those services.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

The Department of Health Care Services (DHCS) posted the following bulletins, notices, and alerts on the Medi-Cal Rx Web Portal.  

• Now Available: Medi-Cal Rx Enteral Nutrition Prior Authorization Request Form (September 22) 
• Enteral Nutrition Shortages (September 22) 
• Medi-Cal Rx Weekly Wrap-Up for September 15 – September 21 (September 22)
• Reinstatement Spotlight (September 22)  
• Reimbursement for New Commercial COVID-19 Vaccines (September 21) 
• Medi-Cal Rx Weekly Wrap-up for September 8-14 (September 15) 
• Reinstatement Spotlight (September 15) 
• 30-Day Countdown: Phase IV, Lift III: Reinstatement of Reject Code 76: Plan Limitations Exceeded (September 13)
• Coming Soon: Commercialization of COVID-19 Vaccines (September 11) 
• State of Emergency Override Activation: Submission Clarification Code 13 (September 8) 
• How to Resolve Claim Rejection Code 78: Cost Exceeds Maximum (September 8) 
• Medi-Cal Rx Weekly Wrap-up for September 1-7 (September 8) 
• Reinstatement Spotlight (September 8) 

Also in California, Medi-Cal posted the following.  

• September 2023 Pharmacy Medi-Cal Update Bulletin 
• September 2023 Durable Medical Equipment and Medical Supplies Medi-Cal Update Bulletin 

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

The Department of Health Care Services (DHCS) posted the following bulletins, notices, and alerts on the Medi-Cal Rx Web Portal. Please note the Updated FAQs (Frequently Asked Questions) for the Pharmacy Retroactive Claim Adjustments.  

• Reinstatement of the Labeler Code Restriction for Brand Name Suboxone (September 5) 
• Reinstatement Spotlight (September 1)  
• Diabetic Supplies Update: Changes to Continuous Glucose Monitoring Systems Policy, Effective October 1, 2023 (September 1) 
• Medical Supplies Update: Updates to Contracted Diabetic Test Strips and Lancets List, Effective October 1, 2023 (September 1)  
• Maximum Allowable Ingredient Cost 30-Day Pharmacy Provider Notice (September 1)  
• Medi-Cal Rx Monthly Bulletin for September (September 1)  
• Changes to Medi-Cal Rx Contract Drugs List (September 1)  
• Updates to the Medi-Cal Rx Provider Manual (September 1) 
• Medi-Cal Rx Weekly Wrap-Up for August 18-24 (August 25)  
• Reinstatement Spotlight (August 25)  
• 30-Day Countdown: Reinstatement of Cost Ceiling and Prior Authorization for Enteral Nutrition and Specific Standard Therapeutic Classes (August 23)  
• Lift of Labeler Code Restriction for Truvada (August 22)  
• Recommencement of Pharmacy Retroactive Claim Adjustments: Publication of Updated Frequently Asked Questions (FAQs) (August 21) 
• Medi-Cal Rx Weekly Wrap-Up for August 11-17 (August 18)  
• Reinstatement Spotlight (August 18) 

Also in California, Gov. Gavin Newsom (D) declared a state of emergency in Del Norte and Siskiyou Counties due to fires. During a declared state of emergency, the Board of Pharmacy reminds licensees of information and state laws intended to help pharmacists provide prescription drugs – including controlled substances – for residents displaced because of emergency evacuation.  

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.