COVID-19 Outpatient Treatment and Preventative Care Resources
| Date: | February 22, 2023 |
| To: | Health Plan of San Joaquin (HPSJ) Physicians and Providers |
| From: | HPSJ Pharmacy and Therapeutics Committee |
| Type: | Formulary/Informational/Educational and Regulatory |
| Subject: | COVID-19 Outpatient Treatment and Preventative Care Resources |
| Business: | Medi-Cal |
The following provides UPDATES from the August 30, 2022 alert:
- Effective on or after November 30, 2022, DHCS and HPSJ will no longer reimburse Bebtelovimab as the FDA has announced that the agent is no longer authorized for emergency use anywhere in the US as it is not expected to neutralize Omicron subvariants BQ.1 and BQ.1.1.
- Effective on or after January 26, 2023, DHCS and HPSJ will no longer reimburse Evusheld as the FDA announced that the agent is unlikely to be active against certain SARS-CoV-2 variants.
Multiple factors must be considered when selecting the appropriate outpatient treatment and preventative care options for COVID-19. The below links can be used to assist in the clinical decision-making process. All covered services are available to members at no cost.
- HHS Clinical Implementation Guide (https://aspr.hhs.gov/COVID19/Therapeutics/Documents/USG-COVID19-Tx-Playbook.pdf)
- HHS Treatment Algorithm (https://aspr.hhs.gov/COVID19/Therapeutics/Documents/COVID-Therapeutics-Decision-Aid.pdf)
- NIH COVID Treatment Guidelines (https://www.covid19treatmentguidelines.nih.gov/)
- CDPH COVID-19 treatment resources (https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID19/Treatments.aspx)
- Link to the “Test-to-treat” centers via the My Turn web page (https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Test-totreat-locations.aspx#)
- Instructions on how to register as a Test-to-Treat provider and receive information about incentives, communications, awareness campaigns, and COVID therapeutics directly from their local health jurisdiction (https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/COVID19-Treatments-Distribution-and-Ordering.aspx)
- Federal Health & Human Services’ COVID Therapeutics Locator (https://covid-19-therapeutics-locator-dhhs.hub.arcgis.com/)
- Available COVID-19 infusion sites within HPSJ’s network (https://www.hpsj.com/covid-19-provider-information/)
| Medical Benefit (Billed via medical claims) | Pharmacy Benefit (Billed via Pharmacy) | |||
|---|---|---|---|---|
| Medication/Vaccine* or Test | Medi-Cal Rx | Medi-Cal FFS | HPSJ | |
| Paxlovid (nirmatrevir/ritonavir) | Yes | No | No | |
| Lagevrio (molnupiravir) | Yes | No | No | |
| Veklury (remdesivir) | Yes | Yes | No | |
| COVID-19 Vaccines | Yes | Yes | No | |
| Prescribed in-home testing kits | Yes | No | Yes | |
| Antibody Testing | No | No | Yes | |
| Vaccine administration fee when performed at the provider’s office or pharmacy | No | Yes | No | |
*All medications/vaccines are federally covered at this time and free to providers/pharmacies, therefore providers/pharmacies will only be reimbursed for the professional dispensing fee via Medi-Cal Fee-For-Service/Medi-Cal Rx.
You may contact our Customer Service Department with any questions or concerns, Monday through Friday, 8:00 am to 5:00 pm, at 1-888-936-PLAN (7526), TDD/TYY 711. Thank you for your continued support of Health Plan of San Joaquin. You may also visit https://www.hpsj.com/alerts/ for online access to this document and additional provider alerts previously shared. The most recent information about Health Plan of San Joaquin and our services is always available on our website https://www.hpsj.com/.