Med-Cal Rx WHAT YOU NEED TO KNOW! About Specialty Medications – Part 1
| Date: | October 28, 2020 |
| To: | Health Plan of San Joaquin (HPSJ) Provider Network |
| From: | Health Plan of San Joaquin |
| Subject: | Medi-Cal Rx, the Pharmacy Carve-Out – Your Bi-Weekly Update ABOUT SPECIALTY MEDICATIONS – First Example Respiratory syncytial virus (RSV): 2020-2021 Palivizumab (SYNAGIS) |
| Business: | Medi-Cal |
The Centers for Disease Control and Prevention (CDC) reports that the Respiratory syncytial virus (RSV) is known as one of the most common illnesses among infants and children. The American Academy of Pediatrics (AAP) recommends the administration of palivizumab (Synagis), to prevent serious RSV illness in qualifying high-risk infants and young children.
RSV is usually seasonal which occurs during fall, winter, and spring. In the Central Valley, the RSV season is between November 1st through March 31st of every year.
Medi-Cal Rx: Transition Postponed
The April 1, 2021 transition to Medi-Cal Rx has been delayed by the California Department of Health Care Services (DHCS). Additional information will come from DHCS. Until further notice, HPSJ will continue to offer the pharmacy benefit.
Palivizumab (SYNAGIS) is one example of how this will work.
- A change is coming for how to facilitate access to Palivizumab (Synagis) for Respiratory Syncytial Virus (RSV) for qualifying high-risk patients.
- Until December 31, 2020 – Diplomat Specialty Pharmacy will continue to supply Synagis and other specialty medications that are outpatient specialty medications.
- Providers must get Synagis from any specialty pharmacy provider that is registered and credentialed through Medi-Cal Rx and has a contract with Sobi.
- Please see the attached Synagis notice for qualifying providers. Health Plan of San Joaquin wants to make sure providers are prepared for this transition.
WATCH FOR YOUR NEXT Medi-Cal Rx Alert –
List of specialty prescribed drugs that must be ordered via Medi-Cal Rx.
Download Attachments
Attachments: 1) 90/60-Day Notice from DHCS to Medi-Cal Members (3 pages)
2) SYNAGIS Limited Distribution Specialty Pharmacy Network (1 page)
Medi-Cal Rx: Transition Postponed
The April 1, 2021 transition to Medi-Cal Rx has been delayed by the California Department of Health Care Services (DHCS). Additional information will come from DHCS. Until further notice, HPSJ will continue to offer the pharmacy benefit.
- Health Plan of San Joaquin pharmacy benefits will be transitioned to and
administered by the new agency, Medi-Cal Rx. - ALL outpatient pharmacy drugs will be covered by Medi-Cal Rx.
- The Department of Health Care Services (DHCS) has partnered with Magellan
Medicaid Administration, Inc. to provide this benefit and support Medi-Cal Rx.
(4) Things you can do NOW!
- Register for the secure Medi-Cal Rx Provider Web Portal.
- Create a plan for your HPSJ patients’ medication starting January 1, 2021. DHCShas created a transition plan to ensure that coverage for beneficiaries’ medication will continue from January 1, 2021.
- Review online, www.Medi-CalRx.dhcs.ca.gov:
- Medi-Cal Rx Pharmacy Transition Policy
- Contract Drug List (CDL)
- List of covered pharmacy providers
- Call, if you have questions:
- Before Jan 1: Medi-Cal Member Help Line, 1-800-541-5555 TTY/TDD 711, Monday through Friday, 8 am to 5 pm.
- As of Jan 1, 2021, Medi-Cal Rx Call Center Line, 1-800-977-2273 TTY/ TDD 711, 24/7, or visit www.Medi-CalRx.dhcs.ca.gov
During this transition, HPSJ wants to make sure our members are served without disruption – and you, your staff and business operations are supported. Look for more from HPSJ in coming days.