The Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal. Please note the reinstatement resources and information below.  

• How to Prepare for Retirement of the Transition Policy (January 12) 
• Drug Use Review (DUR) Alert System Issue: Additive Toxicity (AT) (January 9) 
• Medi-Cal Rx Weekly Wrap-Up for December 29-January 5 (January 6) 
• Reminder: Drugs Supplied to Nursing Facilities (January 6) 
• Reinstatement Spotlight (January 6) 
• Medical Supplies: Updates to the List of Covered Disposable Insulin Delivery Devices (January 4) 
• Now Active – Cal MediConnect Transition to Medicare MediCal Plans (January 1) 
• Medi-Cal Rx Monthly Bulletin for January (January 1) 
• Changes to the Contract Drugs List (CDL) (January 1) 
• Changes to the Contract Drugs List (CDL) – Authorized Drug Manufacturer Labeler Codes (January 1) 
• Changes to the Contract Drugs List (CDL) – Over-the-Counter Drugs (January 1) 
• Changes to the Pharmacy Reimbursable Physician Administered Drugs (January 1) 
• Updates to the Medi-Cal Rx Provider Manual (January 1) 
• Bebtelovimab No Longer Authorized to Treat COVID-19 (December 30) 
• Reinstatement Spotlight (December 30) 
• Reinstatement Spotlight (December 23) 
• Medical Rx Weekly Wrap-Up for December 16-22 (December 23) 
• Monkeypox Vaccine as a Family PACT Pharmacy Benefit (December 21) 
• 90-Day Countdown – Phase III: Retirement of the Transition Policy for Beneficiaries 22 Years of Age and Older (December 20) 
• 30-Day Countdown – Reinstatement of Prior Authorization Requirements for 39 Drug Classes (December 20) 
• Medi-Cal Rx IVR Enhancement to Enable Additional Self-Service Option! (December 20) 
• Reinstatement Spotlight (December 16) 
• Two-Week Countdown – Cal MediConnect Transition to Medicare MediCal Plans (December 16) 
• Medi-Cal Rx Weekly Wrap-Up for December 9-15 (December 16) 

Also in California, Medi-Cal posted the following:   

• Telehealth Flexibilities and Revisions to the Telehealth Provider Manual (January 6) 
• 2023 HCPCS Quarter 1 Update (December 30) 
• Bebtelovimab No Longer Authorized to Treat COVID-19 (December 27) 
• TAR [Treatment Authorization Request] Requirement Removal and FDA Approvals for Veklury ® (December 23) 
• Coming Soon: Expanded Use of Bivalent Dosages Approved for Children 6 Months and Up (December 20) 
• Medi-Cal News: National Correct Coding Initiative Quarterly Update for January 2023 (December 16) 
• December 2022 Durable Medical Equipment and Medical Supplies Medi-Cal Update Bulletin (December 16) 
• December 2022 Pharmacy Medi-Cal Update Bulletin (December 16) 

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

Last week, the Department of Health Care Services (DHCS) announced plans for the reinstatement of prior authorization and the retirement of the transition policy taking place in a series of phases… II, III and IV. A webpage has been developed for “Medi-Cal Rx Reinstatement” that includes information about the timeline, key days, announcements and alerts and resources. If you already receive Medi-Cal Rx alerts, you will also begin to receive Reinstatement alerts. There is no need to subscribe to an additional listserv according to DHCS staff. 

Also in California, the DHCS posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal. Please note the reinstatement resources in New Resources for Reinstatement Education and Support. 

• New Resources for Reinstatement Education and Support (December 12) 
• COVID-19 Antigen Tests Coverage Reminder (December 9)
• Medi-Cal Rx Weekly Wrap-Up for December 2-8 (December 9) 

Also in California, Medi-Cal posted the following:   

• Monkeypox Vaccines Reimbursement at the Medicare Rate (December 13) 
• Erroneous Cal MediConnect (CMC) Notice (December 9) 
• Meet & Greet Event – March 2023 (December 9)
• Meet & Greet Event – February 2023 (December 9) 

Finally in California, NACDS and the California Retailers Association (CRA) sent several joint letters to the Board of Pharmacy addressing issues of concern to members.  

• With respect to e-prescribing requirements effective January 1, 2023, NACDS and CRA are seeking guidance from the Board about how members can comply with requirements to accept electronic prescriptions without advance notice from a vendor with whom they do not have a current business relationship.  
• We are also seeking clarity from the Board via answers to a brief list of questions to provide members the appropriate guidance to aid their efforts to comply with a 2021 law related to pharmacy quotas; recall, this law only applies to companies operating 75 or more pharmacies in the state under one ownership.  
• Finally, we are expressing concern with a proposal under consideration by the board to create a “staffing floor” that may lead to pharmacy closures if at least one clerk or pharmacy technician is not on staff and fully dedicated to performing pharmacy-related services while the pharmacy is open; this proposal would also permit the pharmacist on duty to close the pharmacy if, in their opinion, the staffing at the pharmacy is inadequate to safely fill or dispense prescriptions or provide services in a safe manner without fear of retaliation. We asked to work with the board on solutions so that pharmacies can remain open to their patients.

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

The Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal. Please note the delay in the planned resumption of retroactive adjustments and recoupment activity in “Recommencement of Pharmacy Retroactive Claim Adjustments: Status Update”. Also note the MAIC notice regarding rates effective January 1, 2023 in “Maximum Allowable Ingredient Cost 30-Day Pharmacy Provider Notice”. 

• Recommencement of Pharmacy Retroactive Claim Adjustments: Status Update (December 8)
• Medical Supplies Update: Updates to Diabetic Testing Supplies (December 5) 
• Monkeypox Vaccine as a Medi-Cal Pharmacy Benefit (December 2) 
• 30-Day Countdown – Cal MediConnect Transition to Medicare Medi-Cal Plans (December 2) 
• Medi-Cal Rx Weekly Wrap-Up for November 18-December 1 (December 2) 
• Medi-Cal Rx Monthly Bulletin (December 1)
• Changes to Contract Drugs List (CDL) (December 1) 
• Updates to the Medi-Cal Rx Provider Manual (December 1) 
• Maximum Allowable Ingredient Cost 30-Day Pharmacy Provider Notice (December 1) 
• Now Available: Appendix H – List of Physician Administered Drugs with Reject Code 816 (December 1) 
• NCPDP Reject Code 80 and Diagnosis Documentation of Code 1 Restriction: Status Update (November 30)
• Tabloid 40 mg Update (November 21) 
• Medi-Cal Rx Weekly Wrap-Up for November 11-17 (November 18) 

Also in California, Medi-Cal posted the following:  

• Senior Care Action Network (SCAN) Health Plan Expansion (December 7) 
• CalAIM Mandatory Managed Care Enrollment Transition Phase II (December 7)
• CMC [Cal MediConnect] Plans No Longer Covered in CCI [Coordinated Care Initiative] Counties (December 5) 
• UnitedHealthcare Community Plan of California no Longer a Medi-Cal MCP [Managed Care Plan] in San Diego County (December 1) 
• January 2023 Medi-Cal Provider Training Webinars (November 30) 

Finally in California, the Board of Pharmacy posted the agenda and meeting materials for its meeting scheduled for December 14. Please note the discussion and consideration of statutory proposals to establish a requirement for reporting medication errors to the Institute for Safe Medication Practices (ISMP) and related to working conditions (see Attachment 2). 

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

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

• 45-Day Countdown – Cal MediConnect Transition to Medicare Medi-Cal Plans (November 16) 
• Update to Policy and Billing Guidance for Pharmacy Providers on COVID-19 Oral Antiviral, Paxlovid (November 11) 
• Policy and Payment Allowance Update for Provider-Purchased Bebtelovimab for Treatment of COVID-19 (November 11) 
• Medi-Cal Rx Weekly Wrap-Up for November 4-10 (November 11) 
• NCPDP (National Council for Prescription Drug Programs) Reject Code 80 and Diagnosis Documentation of Code 1 Restriction (November 9) 
• Changes to the Family PACT Pharmacy Formulary (November 7) 
• Prior Authorization Required: Reject Code 75 Reminder (November 4) 
• Medi-Cal Rx Weekly Wrap-Up for October 28-November 3 (November 4) 

Also in California, Medi-Cal posted the following:  

• Medi-Cal Update – Durable Medical Equipment and Medical Supplies – November 2022 Bulletin 566 (November 16) 
• Medi-Cal Update – Pharmacy – November 2022 – Bulletin 1027 (November 16) 

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

The Board of Pharmacy has announced an additional meeting of the Standard of Care Ad Hoc Committee schedule for November 16 and posted an agenda for the meeting. 

Also in California, the Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal. Please note the Medi-Cal recoupment announcement in “Recommencement of Pharmacy Retroactive Claims Adjustments” document; these recoupments are set to begin in January 2023.  

• Medical Supplies: Correction to Limitations for Contraceptive Supply (November 3) 
• Medi-Cal Rx Monthly Bulletin for November (November 1) 
• Changes to the Contract Drugs List (CDL) (November 1) 
• Changes to the Contract Drugs List (CDL) – Over-the-Counter Drugs (November 1) 
• Updates to the Medi-Cal Rx Provider Manual (November 1) 
• Recommencement of Pharmacy Retroactive Claim Adjustments in November 2022 (October 31) 
• Prior Authorization Appeals and Claim Appeals: A Reminder for Providers (October 28) 
• Medi-Cal Rx Weekly Wrap-Up for October 21-27 (October 28) 

Finally in California, Medi-Cal posted the following: 

• Paper RADs, No Pay Documents and EFT Statements Will Soon be Replaced by Electronic Equivalents (November 1) 
• Medi-Cal News: Coming Soon: Booster Dose for Novavax and Pediatric Bivalent Pfizer-BioNTech and Moderna COVID-19 Vaccines (October 31) 
• Medi-Cal Rx Update – Pharmacy – October 2022 – Bulletin 1026 (October 31) 

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

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

• Coverage of Sterile Syringes with Needles (Non-Insulin) (October 26)
• Reminder for Providers Regarding Patient Privacy (October 26)
• Historical Pricing and Reimbursement Corrections for Ixinity, Alprolix, Eloctate, and NovoSeven 4Q 2021 through Q3 2022 (October 25)
• Bivalent COVID-19 Vaccines Administration Now a Benefit (October 21)
• Medical Rx Weekly Wrap-Up for October 14-21 (October 21)

Also in California, the Board of Pharmacy issued its Annual Notice of Availability of Precedential Decisions Index. The index and the text of the precedential decisions are available on the Board’s webpage.

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

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

• Diabetic Supplies: Update to the Minimum Quantity for FreeStyle Libre 3 (October 14)
• Medi-Cal Rx Weekly Wrap-Up for October 7-13 (October 14)
• Medical Supplies: Continuous Glucose Monitoring Systems and Disposable Insulin Delivery Devices Updates (October 7)
• Medical Supplies: Disposable Insulin Delivery Devices Updates (October 7)
• Medi-Cal Rx Weekly Wrap-Up for September 30-October 6 (October 7)

Also in California, Medi-Cal posted the following:

• Coming Soon: Monkeypox Vaccine Reimbursement at the Medicare Rate (October 14)
• October 2022 Pharmacy Medi-Cal Update Bulletin 1025 (October 14)
• October 2022 Durable Medical Equipment and Medical Supplies Medi-Cal Update Bulletin 565 (October 14)

Also in California, Gov. Gavin Newsom (D) announced the State of Emergency and the associated Executive Orders N-39-20 and N-75-20 will end on February 28, 2023. The Department of Consumer Affairs subsequently posted that upon the State of Emergency ending, active waivers that were used under the authority of the State of Emergency and Executive Orders will also expire. For future updates, check the DCA waiver webpage or the Board of Pharmacy website.

Finally in California, the Board of Pharmacy posted the following:

• Standard of Care Agenda and Meeting Materials – October 25 at 9:00 a.m. PDT
• Full Board Agenda and Meeting Materials – October 25 at 1:30 p.m. PDT and October 26 at 9:00 a.m. PDT

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

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

• Diabetic Supplies: Updates to Continuous Glucose Monitoring Systems (October 4)
• Medical Supplies: Continuous Glucose Monitoring Systems and Disposable Insulin Delivery Devices Updates (September 30; Revised October 4)
• Medi-Cal Rx Monthly Bulletin for October (October 1)
• Changes to Contract Drugs List (CDL) (October 1)
• Changes to Contract Drugs List (CDL) – Over-the-Counter Drugs (October 1)
• Changes to Contract Drugs List (CDL) – Authorized Drug Manufacturer Labeler Codes (October 1)
• Changes to Family PACT Pharmacy Formulary (October 1)
• Updates to the Medi-Cal Rx Provider Manual (October 1)
• Diabetic Supplies: Continuous Glucose Monitoring (CGM) Systems Billing Units Reminder, Effective October 1, 2022 (October 1)
• Enteral Nutrition Update: Changes to the List of Covered Enteral Nutrition Products, Effective November 1, 2022, December 1, 2022, and January 1, 2023 (October 1)
• Medical Supplies: Removal of Prior Authorization Requirement for Covered Blood Pressure Cuffs, Effective November 1, 2022 (October 1)
• Medical Supplies: Continuous Glucose Monitoring Systems and Disposable Insulin Delivery Devised Updates (September 30)
• Coming Soon: Bivalent COVID-19 Vaccines (September 30)
• Medi-Cal Rx Weekly Wrap-Up for September 23-29 (September 30)

Also in California, Medi-Cal posted the following:

• Policy Update and Billing Guidance for COVID-19 Oral Antiviral, Paxlovid
• 2022 HCPCS Quarter 4 Update
• 2023 ICD-10-CM/PCS Codes Update
• Medical Supplies Update: MAPC Change for Nonsterile Gloves
• Medi-Cal Update – Pharmacy – September 2022 – Bulletin 1024

Also in California, the Board of Pharmacy posted its Board of Pharmacy Update – October 2022.

In California, Medi-Cal Rx will provide an educational opportunity regarding Brand Medically Necessary Prior Authorizations (DAW 1) and implications for pharmacy providers related to the Dispense as Written (DAW), Brand Medically Necessary (BMN), and Reimbursement – Frequently Asked Questions (FAQs) and Submission of Pricing Prior Authorization for Brand Medically Necessary Medications: Dispense as Written 1 (DAW1), released on September 29. Please join the Zoom meeting on October 10 at 1:00 p.m. Pacific using the following:

https://magellanhealth.zoom.us/j/93157317543?pwd=ZzlGRE9FNWtZWWtqb2FRZzcyMmE3Zz09&from=addon

Password: 924224

or iPhone one-tap (US Toll): +16699006833,93157317543# or +13462487799,93157317543#

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

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

• Submission of Pricing Prior Authorization for Brand Medically Necessary Medications: Dispense as Written (DAW 1) (September 29) 
• Enteral Nutrition: Powder Dispensed in Packets, Billing Units Reminder (September 27) 
• CoverMyMeds: Provider Support (September 27) 
• Enteral Nutrition Update: Changes to the List of Covered Enteral Nutrition Products, Retroactive to September 1, 2022 (September 23) 
• Medi-Cal Rx Weekly Wrap-Up for September 16-22 (September 23)  

Also in California, this week, Medi-Cal posted “Medi-Cal Provider “Coffee Break” Event.” 

Finally in California, the Board of Pharmacy posted the agenda for the Enforcement and Compounding Meeting scheduled for October 4.  

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