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

• Diabetic Supplies Updates: Changes to the Lists of Covered Diabetic Test Strips and Lancets and Covered Self-Monitoring Blood Glucose Systems (Glucometers), Control Solutions, and Lancing Devices, Effective November 20, 2022 (September 20)  
• Medical Supplies and Enteral Nutrition Coverage Reminder (September 19) 
• Now Active – Physician Administered Drug Policy Updates (September 16) 
• Now Active – Reinstatement of Limited Prior Authorization Requirements for 11 Drug Classes (September 16) 
• Medi-Cal Rx Weekly Wrap-Up for September 9-15 (September 16) 
• Informational Claim Message: Prescriber Enrollment (September 15)  
• Medi-Cal Enrollment for Ordering, Referring, Prescribing Providers (September 15) 

Also in California, Medi-Cal posted the following:   

• Billing Update for Bebtelovimab Use for COVID-19 Treatment (September 20) 
• National Correct Coding Initiative Quarterly Update for October 2022 (September 16) 
• Addition of Novavax COVID-19 Vaccine (September 16) 
• Medi-Cal Update – Durable Medical Equipment and Medical Supplies – September 2022 – Bulletin 564 (September 16) 
• Medi-Cal Update – Pharmacy – September 2022 – Bulletin 1023 (September 16) 
• New Laboratory Test for Orthopoxvirus is a Medi-Cal Benefit (September 16) 

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

NACDS and the California Retailers Association (CRA) sent the following joint letters to Gov. Gavin Newsom (D): 

• Requesting his signature on SB (Senate Bill) 1259, which would allow pharmacists to furnish opioid antagonists, approved by the U.S. Food and Drug Administration, without a prescription. Gov. Newsom subsequently signed the bill on September 2 (Chapter 245, Statues of 2022).  

• Requesting a veto of the AB (Assembly Bill) 852, related to e-prescribing, because it was not amended as requested. Anticipating that a veto is unlikely, we also reached out to the Governor’s legislative secretary and asked that, if the bill does get signed, the Governor include a signing message as follows: In approving AB 852, it is not my intent to force pharmacies to accept an electronic prescription without first having the time to ensure that the software via which the electronic prescription is submitted is compliant with Section 688(b)(3), as well as time for the pharmacy to undertake necessary system changes to become compatible with the software.  
• Stating a neutral position on AB 1341, legislation prohibiting the sale of dietary supplements for weight loss or over-the-counter diet pills to individuals under 18 years of age without a prescription. As currently drafted, AB 1341 does not require retailers to limit customer access to dietary supplements, e.g., caging requirement, that was our primary concern with the bill.  

Also in California, NACDS along with the California Pharmacists Association and the California Retailers Association jointed over 30 additional organizations in a letter to Gov. Gavin Newsom (D) thanking him for facilitating access by diabetes patients to continuous glucose monitors (CGMs) and care by exempting CGMs from Medi-Cal provider cuts in this year’s State Budget. CGMs were added as a covered Medi-Cal benefit for adult patients with diabetes just this past January. However, because of the cross operation of a decade-old law (AB 97 Ch.3/2011), Medi-Cal reimbursements for CGMs were below actual costs, making it unfeasible for some providers to offer these life-changing medical devices to patients. 

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

• September 2022 is Opioid, Heroin, Fentanyl, and Prescription Drug Abuse Awareness Month 
• Board of Pharmacy Update – August 2022 

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

• Enteral Nutrition Update to the List of Covered Enteral Nutrition Products, Retroactive to September 1, 2022 (September 14) 
• One-Week Countdown – Reinstatement of Prior Authorization Requirements for 11 Drug Classes (September 9) 
• Medi-Cal Rx Weekly Wrap-Up for September 2-8 (September 9) 
• Two-Week Countdown – Reinstatement of Prior Authorization Requirements for 11 Drug Classes (September 2)
• Medi-Cal Rx Weekly Wrap-Up for August 26-September 1 (September 2) 
• Medi-Cal Rx Monthly Bulletin for September (September 1) 
• Changes to Contract Drugs List (CDL) (September 1) 
• Changes to Contract Drugs List (CDL) – Over-the-Counter Drugs (September 1) 
• Changes to Family PACT Pharmacy Formulary (September 1)
• Updates to Medi-Cal Rx Provider Manual (September 1) 
• Medical Supplies: Updates to the List of Covered Disposable Insulin Delivery Devices (September 1) 
• Diabetic Supplies: Updates to Continuous Glucose Monitoring Systems (September 1) 
• Maximum Allowable Ingredient Cost 30-day Pharmacy Provider Notice (September 1) 
• Reminder to Providers: COVID-19 Oral Antivirals for Uninsured Group (August 30) 
• Phase I, Wave III Prior Authorization Submission (August 26) 
• Medi-Cal Rx Weekly Wrap-Up for August 19-25 (August 26)
• COVID-19 Vaccine Now a Benefit for Pediatric Population (August 23) 
• Enteral Nutrition Update: Renastep (Vitaflo, USA, LLC) Product-Specific Criteria Removed, Effective September 1, 2022 (August 22) 
• Medi-Cal Rx Weekly Wrap-Up for August 12-18 (August 19) 
• 30-day Countdown – Reinstatement of Prior Authorization Requirements for 11 Drug Classes (August 16) 
• Prior Authorization Reinstatement Reference Guide (August 16) 
• Phase I, Wave III List of Drug Impacted by Prior Authorization Reinstatement (August 16) 
• COVID-19 Vaccine: Single Booster Dose for Children Ages 5-11 (August 15) 
• Medi-Cal Rx Weekly Wrap-Up for August 5-11 (August 12) 

Also in California, Medi-Cal posted the following:  

• Coming Soon: Bivalent Booster Dose for Select COVID-19 Vaccines (September 14) 
• October 2022 Medi-Cal Provider “Coffee Break” Event (September 12) 
• Medi-Cal Update – Pharmacy – August 2022 – Bulletin 1022 (August 31) 
• Monkeypox (Mpox) Vaccine Administration; General Updates (Updated August 29) 
• Reminder: COVID-19 Oral Antivirals for Uninsured Group (August 22) 

Finally in California, the CRA reported that SB 301, the state’s version of the federal INFORM Consumers Act, has been sent to Gov. Newsom for his signature or veto.

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

Medi-Cal posted the following: 

• New ICD-10-CM and ICD-10-PCS Codes Related to COVID-19 
• Durable Medical Equipment and Medical Supplies bulletin – August 2022 – Bulletin 563 
• Medi-Cal Update – Pharmacy – August 2022 – Bulletin 1021
• Beneficiary Eligibility Verification Reminder 

Also in California, the Department of Health Care Services posted the following alerts on the Medi-Cal Rx Web Portal. 

• Coming Soon: COVID-19 Vaccine for Children 6 Months and Up (August 9) 
• Code 1 Documentation and Postponement of Implementation of NCPDP (National Council for Prescription Drug Programs) Reject Code 80 (August 8)
• Medi-Cal Rx Weekly Wrap-Up for July 29-August 4 (August 5) 

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

• Enforcement and Compounding Committee Meeting Agenda – August 25, 2022 
• Standard of Care Committee Meeting Agenda and Meeting Materials – August 25, 2022 
• Full Board Meeting Agenda and Meeting Materials – August 25, 2022 
• August 2022 issue of “The Script”, the Board’s newsletter 
• Order of Adoption for Approved Regulation: Notification of Temporary Closure – Effective October 1, 2022 

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

Medi-Cal posted the following:

• News: “Coming Soon: Novavax COVID-19 Vaccine Authorization” – The Department of Health Care Services is aggressively pursuing the necessary system and operational changes required to enable successful claims adjudication for administration of the Novavax COVID-19 vaccine. (August 3)
• News: “New Provider Financial Data Request Form Available” – Providers should use the Financial Data Request Form for questions regarding missing warrants, copies of Remittance Advice Details (RADs), accounts receivable transactions, and copies of 1099s. (August 3)
• News: “New Approval Messages for COVID-19 Uninsured Group User Guide” was posted to the Medi-Cal News – COVID-19 Uninsured Group (UIG) coverage will be updated with new approval messages for qualifying individuals. (July 29)
• Alert: “Temporary Problem for Real-Time Eligibility Transactions” – The Medi-Cal Program has been affected by a temporary problem that has affected all providers using CalPOS leased line connection for Real-Time eligibility transactions. (July 29)

Also in California, the Department of Health Care Services posted the following alerts on the Medi-Cal Rx Web Portal.

• Enteral Nutrition Updates to the List of Covered Enteral Nutrition Products, Effective September 1, 2022, and December 1, 2022 (August 1)
• Medi-Cal Rx Monthly Bulletin for August (August 1)
• Changes to Contract Drugs List (CDL) (August 1)
• Updates to the Medi-Cal Rx Provider Manual (August 1)
• Electronic Claims Agreement – Submission Deadline Extended (July 29)
• Medi-Cal Rx Weekly Wrap-Up for July 22-28 (July 29)

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

• NEW Pharmacy Law Waiver: Prescriber Dispensing of Tecovirimat (TPOXX or ST-246) Oral Antiviral Medication to Emergency Room Patient (BPC sections 4068(a)(1), 4068(a)(5), 4068(a)(6), 4076.5 and 4427.2(a))
• Next Standard of Care Committee Meeting – August 25, 2022 (NEW DATE)
• Notice of Second Modified Text to amend sections 1793.5 and 1793.6 and to add section 1793.65 to Title 16 of the California Code of Regulations related to Pharmacy Technicians and Second Modified Text; written comments will be accepted until August 17, 2022.
• Effective January 1, 2023, Order of Adoption amending Division 17 of Title 16 of the California Code of Regulations, section 1715.65, related to Inventory Activities and Inventory Reconciliation Reports of Controlled Substances

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

The Board of Pharmacy, Department of Consumer Affairs (DCA) and the Department of Health Care Access and Information (HCAI) issued a reminder to complete the workforce survey. HCAI, in partnership with the Board of Pharmacy and DCA, developed a workforce survey for individuals to complete during the electronic licensure renewal process. Individuals are asked to contribute to this important data collection effort by completing the survey at the time of licensure renewal. Please feel free to contact HCAI at workforcedata@hcai.ca.gov. Answers to frequently asked questions (FAQs) about the HCAI licensure data collection are also posted on the Board’s website under License Renewal Online.

Also in California, NACDS and the California Retailers Association (CRA) submitted a joint letter to the Board of Pharmacy expressing members’ concerns with recent delays in approvals of licenses and permits by the Board of Pharmacy.  In the letter, we offered to work with the Board on solutions to this issue to ensure demand for critical medications and other pharmacy services are being met.

Also in California, NACDS and CRA submitted a joint letter to the Senate Appropriations Committee to “opposed unless amended” AB 852, legislation that would revise requirements originally enacted under AB 2789 (Wood, Ch. 438, Statutes of 2018) pertaining to e-prescribing.  Of particular concern, AB 852 would require pharmacies to accept electronic prescriptions without advance notice and minus the lead time necessary to build out system capabilities both internally and with external system vendors to accommodate this.  NACDS and CRA urge lawmakers to amend the legislation to clarify that pharmacies do not have to accept electronic prescriptions from software vendors without a mutually agreeable contractual relationship with a pharmacy that includes assurances of interoperability and complies with applicable laws, regulations and industry standards.

Also in California, the Department of Health Care Services posted the following alerts on the Medi-Cal Rx Web Portal.

• Update: Implementation of Phase I, Wave III – Reinstatement of Prior Authorizations for 11 Drug Classes (July 26)
• Now Active – Reinstatement of Reject Code 88 (July 22)
• Medi-Cal Rx Weekly Wrap-Up for July 15-21 (July 22)

Finally in California, on July 28, Medi-Cal posted the following:

• Alert: “Real Time Eligibility Transactions” – Medi-Cal is currently experiencing intermittent technical difficulties with the Point of Service system network for eligibility transactions submitted by Leased Line users.
• News: “Coming Soon: Laboratory Test CPT Code for the Orthopoxvirus” – New CPT code 87593 created to streamline the reporting of moneypox testing. A notification for claims submission to follow.
• News: “Update for Paper RADs and No Pay Documents” – The discontinuance of paper RAD, Electronic Fund Transfer and No Pay documents has been extended. No future discontinuance date has been announced.

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

The Department of Health Care Services (DHCS) posted the July 2022 Durable Medical Equipment and Medical Supplies Bulletin 562 including the following updates: 

• Pfizer COVID-19 Vaccine Booster Dose Authorized for Individuals 5 to 11 Years of Age 
• 2022 COVID-19 Vaccine Administration FAQs Available 
• 2022 HCPCS Quarter 3 Update 
• Tax Status Change for Select HCPCS Codes
• Guidance for Respiratory DME Codes E0482 and E0483 Updated 
• September Virtual Claims Assistance Room Event  

In addition, the Part 1 – Program and Eligibility bulletin was posted to the Medi-Cal website. 

Also in California, the DHCS posted the July 2022 Pharmacy Bulletin 1019 on the Medi-Cal website with content similar to the bulletin above with the addition of O&P Services Recategorized as Surgery Supplies.  

Also in California, the DHCS posted “Paper RADs [Remittance Advice Details] AND No Pay Documents Will No Longer Be Mailed Due to Supply Chain Issues.” Effective, July 18, 2022, RAD (Remittance Advice Details), EFT [Electronic Funds Transfer] and No Pay documents will only be available electronically. There is no impact on paper warrants or direct deposit payments. Additionally, the Medi-Cal Checkwrite Schedule will remain unchanged. Additionally, providers will be able to access them online PDF RADs and HIPAA 835 files as published. Providers who have not yet transitioned to the PDF RADs are encouraged to do so.  

Also in California, the Department of Health Care Services posted the following alerts on the Medi-Cal Rx Web Portal.  

• Inappropriate Treatment Delays and Denials for HIV PrEP and PEP (July 19) 
• One-Week Countdown – Reinstatement of Reject Code 88 (July 15) 
• Two-Week Reminder: Electronic Claims Agreement – Submission Deadline Extended to July 31, 2022 (July 15) 
• Medi-Cal Weekly Wrap-Up for July 8-14 (July 15) 

Finally in California, the Board of Pharmacy posted its meeting agenda and meeting materials for the July 27-28 Full Board Meeting. 

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

On June 27, Gov. Gavin Newsom (D) signed SB (Senate Bill) 154 (Chapter 43) which includes language allocating $114.4 million to forgive the retroactive reduction of claims reimbursement for independent pharmacies in 2022-23. Another $28.4 million will be allocated in 2023-24. This was due to an error in the implementation of the actual acquisition cost reimbursement methodology for dates of service from April 1, 2017, to February 22, 2019, inclusive. On June 30, Gov. Newsom signed AB (Assembly Bill) 178 (Chapter 45) that directs the Department of Health Care Services to forego the recoupment of overpayments from independent pharmacies and defined “independent pharmacy” as a pharmacy owned by a person or entity who owns not more than 74 pharmacies in California. Also, on June 30, the Governor signed SB 184 (Chapter 47), the health trailer bill, that expands telehealth and exempts continuous glucose monitors and medication therapy management services from a 10 percent provider cut based on 2011 legislation.  

Also in California, the Department of Consumer Affairs issued this waiver extension on July 11: DCA Waiver DCA-22-217 Order Waiving Restrictions on Pharmacists Independently Initiating and Furnishing Paxlovid to Individual Patients. The full waiver and a list of current waivers is available on the DCA website. 

Also in California, the Board of Pharmacy recently communicated the following: 

• Complaints about Pharmacy Performance Quotas 
• July 18 at 9:00 a.m. – Licensing Committee Meeting Agenda and Meeting Materials 
• July 18 at 1:00 p.m. – Legislation and Regulation Committee Meeting Agenda and Meeting Materials 
• July 19 at 9:00 a.m. – Enforcement and Compounding Committee Meeting Agenda and Meeting Materials 
• July 19 at 1:00 p.m. – Communication and Public Education Committee Meeting Agenda and Meeting Materials 

Also in California, the Department of Health Care Services posted the following alerts on the Medi-Cal Rx Web Portal. Please note this week’s announcement about the postponement of implementation of NCPDP (National Council for Prescription Drug Programs) reject code 80 and the reminder about the July 31 deadline for all participating Medi-Cal Rx pharmacy providers and billers to submit a Medi-Cal Rx Telecommunications Provider and Biller Application/Agreement Form to continue submitting electronic claims without interruption. 

• Prescriber Advantages of Using CoverMyMeds® for Medi-Cal Rx Prior Authorization Requests (July 13) 
• Update: Postponement of Implementation of NCPDP Reject Code 80 (July 12) 
• Changes to Medical Supplies Reimbursement Methodology, Effective July 1, 2022 (July 8) 
• Medi-Cal Rx Weekly Wrap-up for July 1-7 (July 8)
• Second Booster Dose for Targeted Populations (July 7) 
• Medi-Cal Rx Training Catalog (July 5) 
• Medi-Cal Rx Weekly Wrap-up for June 24-30 (July 1) 
• Medi-Cal Rx Monthly Bulletin for July (July 1) 
• Changes to the Contract Drugs List (CDL) (July 1)
• Changes to the Contract Drugs List (CDL) – Authorized Drug Manufacturer Labeler Codes (July 1) 
• Updates to the Medi-Cal Rx Provider Manual (July 1) 
• 30-Day Reminder: Electronic Claims Agreement – Submission Deadline Extended to July 31, 2022 (June 30) 
• Medi-Cal Rx Office Hour – Reinstatement of Reject Codes 80 and 88 (June 29) 
• Reminder: Fiscal Year Two-week Fee-for-Service Hold for Specific Provider Payments (June 29)
• Now Available: Medi-Cal Rx Telecommunications Provider and Biller Application/Agreement Form – Supplemental Form (June 27) 
• Enteral Nutrition Updates Additions, Effective July 1, 2022 (June 24) 
• Medi-Cal Rx Weekly Wrap-up for June 17-23 (June 24) 
• Medi-Cal Rx Point-of-Sale Messaging Update (June 22) 
• Appendix A: Reject Code 88 DUR: Service Codes Scenarios (June 22)
• NDPDP Reject Code 88 DUR Reference Guide (June 22) 
• NCPDP Reject Code 80 Reference Guide (June 22) 
• 30-Day Countdown – Reinstatement of Reject Codes 80 and 88 (June 22) 
• Medi-Cal Rx Weekly Wrap-up for June 10-16 (June 17) 

Finally in California, the Department of Health Care Services posted the “August 2022 Medi-Cal Provider Training Webinars”. 

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

This week, the State Health and Human Services Agency Secretary and the Director of the State Department of Public Health along with the State Public Health Officer issued a joint statement supporting the recommendation by the Western States Scientific Safety Review Workgroup, the U.S. Centers for Disease Control (CDC), the American Academy of Pediatrics and the Federal Food and Drug Administration (FDA) to grant emergency use authorization (EUA) of the Pfizer-BioNTech and Moderna COVID-19 vaccines for children as young as 6 months of age. 

Also in California, the Board of Pharmacy sent a notice about reissued pharmacy law waivers in response to Gov. Gavin Newsom’s (D) declaration of emergency and the nation declaration of emergency.  

• Staffing Ratio of Pharmacists to Intern Pharmacists and General Supervision and Interprofessional Supervision – Immunizations – BPC section 4114 – The amended expiration date is December 31, 2022, or until 30 days after the emergency declaration is lifted, whichever is sooner. 
• Mass Vaccination Sites – The amended expiration date is December 31, 2022, or until 30 days following the declared disaster, whichever is sooner. 
• Prescriber Dispensing of COVID-19 Antiviral Medication to an Emergency Room Patient (including BPC sections 4068(a)(1), 4068(a)(5), 4068(a)(6), 4076.5, and 4427.2(a)) – The amended expiration date is 30 days following the end of the declared disaster. 

These waivers and all Pharmacy Law waivers are posted under COVID-19 Updates and Resources on the Board’s website. 

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

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

• Enteral Nutrition Updates: Interchange of Equivalent Contracted Enteral Nutrition Product and Specialty Infant Authorization Term Limit (June 18) 
• Medi-Cal Rx Weekly Wrap-Up for June 3-9 (June 10) 

Also in California, Medi-Cal posted the following updates. 

• June 2022 Durable Medical Equipment and Medial Supplies Medi-Cal Update Bulletin (June 16) 

1. 1. Respiratory Supplies: Updates to the List of Medical Supplies Billing Codes, Units and Quantity Limits 
   2. National Correct Coding Initiative Quarterly Update for July 2022 
   3. July 2022 Medi-Cal Provider “Coffee Break” Event 
   4. August 2022 Medi-Cal Provider Training Webinars 
   5. Get the Latest Medi-Cal News: Subscribe to MCSS (Medi-Cal Subscription Service) Today 
   6. Provider Manual Revisions 

• June 2022 Pharmacy Medi-Cal Update Bulletin (June 16) 

• • Update: Second Booster Dose for Select COVID-19 Boosters Now a Benefit 
  • Age Eligibility and Availability Revised for Cabenuva 
  • New Medi-Cal Benefit for Hepatitis B Vaccine
  • Respiratory Supplies: Updates to the List of Medical Supplies Billing Codes, Units and Quantity Limits 
  • One Time Injection Administration Fee Update 
  • National Correct Coding Initiative Quarterly Update for July 2022 
  • July 2022 Medi-Cal Provider “Coffee Break” Event 
  • August 2022 Medi-Cal Provider Training Webinars 

• Part 1 – Program and Eligibility bulletin 

Finally in California, the Board of Pharmacy has posted the following agendas for next week’s June 22 ad hoc committee meetings. 

• Teleconference Standard of Care Committee Meeting agenda 
• Teleconference Medication Error Reduction and Workforce Committee Meeting agenda 

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