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 June 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 |
| J0013 | Esketamine (Spravato) | New PA criteria | |
| J0585 | OnabotulinumtoxinA (Botox) | Modified PA criteria for diagnosis of chronic migraine | Two or more of the following classes of preventive medications:
|
| J0585 | OnabotulinumtoxinA (Botox) | New PA criteria for diagnosis of gastroparesis | Metoclopramide, erythromycin and an antiemetic (such as ondansetron or promethazine) |
The Alliance has updated the following pharmacy policies:
- 403-1101: Pharmacy Operations Management
- 403-1101: Attachment A Medi-Cal Rx MCP Portal Procedures
- 403-1101: Attachment B Medi-Cal Rx Designated User Management
- 403-1103: Pharmacy Authorization Request Review Process
- 403-1109: Non-FDA Approved Drugs and Herbal Remedies
- 403-1112: Therapeutic Equivalence of Generic Drugs
- 403-1142: Biosimilars
- 403-1144: Pharmacy Provision of Family Planning Services
- 403-1146: Drug Waste Reimbursement Policy
- 403-1151: Home Infusion Policy
- 403-1154: Naloxone Distribution Program
- 403-1160: TotalCare Pharmacy Part B Organization Determination Process for D-SNP Members
- 403-1162: TotalCare (HMO D-SNP) Drug Management Program
To request a copy, please call the Alliance Pharmacy Department at 831-430-5507.
Alliance preferred physician-administered drugs
This table is designed to support clinical decision making by highlighting Alliance preferred physician-administered drugs. Please consider these preferred options when appropriate, while continuing to use clinical judgment to determine the best therapy for each individual patient. Note: preferred medications may still require a prior authorization.
| Therapeutic Class | Alliance Preferred Medication (HCPCS) | Non-Preferred Medication (HCPCS) |
| Granulocyte colony-stimulating factor (G-CSF) | Filgrastim biosimilars:
|
J1442- Neupogen (filgrastim) |
| Long-acting G-CSF | J2506 – Neulasta (pegfilgrastim) | Pegfilgrastim biosmilars:
|
| Anti-CD20 monoclonal antibodies | Rituximab biosimilars:
|
J9312 – Rituxan (rituximab) |
| Chemotherapy- bevacizumab | Bevacizumab biosimilars:
|
J9035 – Avastin |
| Anti-VEGF (ophthalmology) | Avastin (J9035) trial first then Lucentis (J2778) |
|
| Osteoporosis | J3489 – Zoledronic acid |
|
| Injectable iron |
|
|
