Please review the following information on physician-administered drugs (PADs) changes and Alliance preferred PADs. Note: these updates are for Medi-Cal and IHSS only.
For more information on physician-administered drugs, including criteria and policies, please visit our website:
- Physician-administered drugs (for Medi-Cal and IHSS).
- Physician-administered drugs (TotalCare HMO D-SNP).
PADs changes effective September 1, 2026
The Alliance has made changes to physician-administered drug benefits. You can find prior authorization (PA) criteria on our website.
The changes are as follows:
| HCPCS Code | Drug | Change | Preferred Drug |
| J9053 | Belantamab mafodotin (Blenrep) | PA required | n/a |
| J9003 | Camcevi ETM | New PA criteria | n/a |
| J2361 | Depemokimab (Exdensur) | New PA criteria | Dupixent (dupilumab),
Fasenra (benralizumab), Nucala (mepolizumab), or Tezspire (Tezepelumab-ekko) |
| Q5154 | Omalizumab-igec (Omlyclo) | Modified PA criteria | Dependent on diagnosis:
· Inhaled corticosteroids (asthma). · High dose antihistamine (chronic spontaneous urticaria). · Nasal corticosteroid (chronic rhinosinusitis with nasal polyps). |
| J2357 | Omalizumab (Xolair) | ||
| J7318 | Durolane | Modified PA criteria | Acetaminophen, NSAID and two intra-articular steroid injections |
| J7320 | Genvisc 850 | ||
| J7321 | Hyalgan, Supartz, Supartz FX, Visco-3 | ||
| J7322 | Hymovis, Hymovis One | ||
| J7323 | Euflexxa | ||
| J7324 | Orthovisc | ||
| J7325 | Synvisc, Synvisc-One | ||
| J7326 | Gel-One | ||
| J7327 | Monovisc | ||
| J7328 | Gelsyn-3 | ||
| J7329 | Trivisc |
The Alliance has updated the following pharmacy policies:
- 403-1114: Continuing Pharmacy Care for New Members(opens in new tab)
- 403-1123: Drugs for the Treatment of Sexual or Erectile Dysfunction(opens in new tab)
- 403-1124: Drug Recall Procedure(opens in new tab)
- 403-1126: Pharmaceutical Services Access(opens in new tab)
- 403-1143: Drug Utilization Review(opens in new tab)
- 403-1145: Pharmacy 340B Program(opens in new tab)
- 403-1147: CCS Pharmaceuticals Policy(opens in new tab)
- 403-1148: Mail Order Pharmacy Services(opens in new tab)
- 403-1152: Site of Care(opens in new tab)
- 403-1153: Botulinum Toxin for Spasticity and Dystonia In Children(opens in new tab)
- 403-1163: Pharmacy Benefit Manager
To request a copy, please call the Alliance Pharmacy Department at 831-430-5507.
