New diabetes program for providers + Medi-Cal Rx updates
New Provider Manual effective April 1, 2023 is available
Please review the updated Provider Manual, effective April 1, 2023.
New! Pharmacist-Led Academic Detailing Diabetes Program
Improve patient outcomes and your clinic’s Care Based Incentive scores by enrolling in this free program offered to Alliance clinicians!
This program will also be offered as part of the Care-Based Quality Improvement Program (CB QIP), which provides financial investment for practices to make quality improvement interventions.
How does the program work?
Clinicians are invited to work directly with an Alliance pharmacist in a series of ten 45-minute virtual interactive educational sessions.
Using an academic detailing approach, sessions will cover evidence-based diabetes pharmacotherapy topics such as:
- The American Diabetes Association’s 2023 Standards of Care in Diabetes.
- Managing co-morbid conditions with a person-centered approach.
- Clinical pearls and strategies to optimize patient outcomes, minimize hypoglycemia and overcome therapeutic inertia.
- Motivational interviewing as a tool to empower and encourage patient engagement.
Throughout the program, we ask for:
- Clinician participation and engagement.
- Patient outreach and scheduling of follow-up appointments and labs per diabetes care recommended guidelines.
Participating clinics have been able to decrease A1Cs in 70% of participating patients. We hope to achieve the same results at your clinic!
Sign up today!
To learn more about the program and to sign up, please email [email protected]. Include the phrase “Pharmacy-Led Academic Detailing” in the subject line.
As of April 21, Medi-Cal Rx PA requirements will be reinstated for 17 additional drug classes
On April 21, 2023, Phase III, Lift 2 of the Medi-Cal Rx Claim Edits and Prior Authorization Reinstatement Plan will be implemented. This part of the plan lifts the Transition Policy for 17 additional drug classes.
The phased approach for PA reinstatements enables providers to gradually submit PAs for renewing prescriptions, or to transition beneficiaries to medications and products on the Contract Drugs List (CDL) and/or Covered Products Lists.
After April 21, 2023, prior authorization requirements will be reinstated for the following drug classes:
| Phase III, Lift 2 Drug Classes | |||
| Contraceptives and Hormones | Ophthalmic, Nasal, and Otic Preparations | Thyroid Agents | Topical Anesthetic Agents |
| Dermatologic Agents
|
Biologic Agents | Glucocorticoids and Corticotropins | Anti-Parkinson’s |
Please note:
The following are exempt from Phase III: Retirement of the Transition Policy:
- Beneficiaries 21 years of age and younger.
- Enteral nutrition products for beneficiaries of all ages.
What pharmacy providers and prescribers need to do
If a beneficiary is currently receiving a medication in a drug class listed in the table above, pharmacy providers and prescribers can consider the following options:
- Consider covered therapies that may not require a PA, if clinically appropriate. Review the following:
- Medi-Cal Rx Contract Drugs Lists & Covered Products Lists.
- Medi-Cal Rx Approved NDC List.
- Prescribers: Refer to your ePrescribing application.
- If a change in therapy is not appropriate, submit a PA request via one of the approved Medi-Cal Rx submission methods:
- CoverMyMeds®.
- Medi-Cal Rx Secured Provider Portal.
- Fax.
- U.S. Mail.
For information on how to submit PA requests in advance of the Transition Policy retirement, please see the March 10 DHCS notification.
You can find additional resources for Phase III, Lift 2 in the March 21 DHCS notification.
Questions?
Call the Medi-Cal Rx Customer Service Center at 800-977-2273 (available 24/7) or email Medi-Cal Rx Education & Outreach at [email protected].
