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.

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.