Cal. Code Regs. Tit. 22, § 51313.3 - Limitations on Coverage of Drugs on the Medi-Cal List of Contract Drugs
(a) Drugs on the
Medi-Cal List of Contract Drugs shall have the limitations specified in (b)
through (g) below.
(b) Code 1 drugs
on the List of Contract Drugs marked "*", require prior authorization in
accordance with Section
51003 unless used under the
conditions specified on the Medi-Cal List of Contract Drugs, and are subject to
the prescription documentation requirements of Section
51476(c).
(c) Where drugs are listed by specific dosage
forms, their use is limited to such method of administration (e.g., ophthalmic
ointments are limited to ophthalmic use) unless prior authorization is
obtained.
(d) When a manufactured
dosage form or strength is specifically listed, only those dosage forms or
strengths listed are allowable for payment, unless prior authorization is
obtained. A listed drug, except intravenous solutions, when prepared by the
provider in an unlisted dosage form or strength, does not require prior
authorization. Long-acting dosage preparations require prior authorization
unless specifically listed. Long-acting dosage preparations are drug products
physically constructed to give slow-release therapeutic effect.
(e) Common household remedies and the
following items are not covered:
(1) Nonlegend
drug preparations;
A. Benzoic and Salicylic
Acid Ointment (precompounded)
B.
Salicylic Acid Cream or Ointment
C.
Salicylic Acid Liquid
D. Sodium
Chloride Tablets 1Gm
E. Sodium
Chloride Tablets 2.5Gm
F. Zinc
Oxide Paste
G. Nonlegend Analgesics
except for those in part 2 of the Medi-Cal List of Contract
Drugs.
(2) Enteral
nutritional supplements or replacements, except that these items may be
covered, subject to prior authorization, if used as a therapeutic regimen to
prevent serious disability or death in patients with medically diagnosed
conditions that preclude the full use of regular food.
(3) Vitamin combinations for person over 5
years of age, except for prenatal vitamin-mineral combination products included
in part 2 of the Medi-Cal List of Contract Drugs or legend prenatal
vitamin-mineral combination products, subject to prior authorization, for use
during pregnancy.
(f)
Only nonlegend cough and cold drug products which meet the requirements of part
3 of the Medi-Cal List of Contract Drugs are covered. Time-release products are
not covered under part 3 of the Medi-Cal List of Contract Drugs.
(g) This section does not apply to items
administered or dispensed as part of a physician's, dentist's, or podiatrist's
service.
Notes
2. New section refiled 9-19-91 as an emergency; operative 9-20-91 (Register 92, No. 4). A Certificate of Compliance must be transmitted to OAL 1-20-92 or emergency language will be repealed by operation of law on the following day.
3. New section refiled 1-23-92 as an emergency; operative 1-17-92 (Register 92, No. 25). A Certificate of Compliance must be transmitted to OAL 5-22-92 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 1-23-92 order transmitted to OAL 5-22-92 and filed 7-6-92 (Register 92, No. 28).
5. Amendment of subsection (e)(3) filed 1-9-95; operative 3-1-95 (Register 95, No. 2).
Note: Authority cited: Sections 14105 and 14124.5, Welfare and Institutions Code. Reference: Sections 14105, 14105.35, 14105.39 and 14132, Welfare and Institutions Code.
2. New section refiled 9-19-91 as an emergency; operative 9-20-91 (Register 92, No. 4). A Certificate of Compliance must be transmitted to OAL 1-20-92 or emergency language will be repealed by operation of law on the following day.
3. New section refiled 1-23-92 as an emergency; operative 1-17-92 (Register 92, No. 25). A Certificate of Compliance must be transmitted to OAL 5-22-92 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 1-23-92 order transmitted to OAL 5-22-92 and filed 7-6-92 (Register 92, No. 28).
5. Amendment of subsection (e)(3) filed 1-9-95; operative 3-1-95 (Register 95, No. 2).
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