Medi-Cal Benefit Updates
| Date: | February 07, 2024 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Pharmacy and Therapeutics Committee |
| To: | Physicians and Providers |
| Type: | Formulary |
| Subject: | Medi-Cal Benefit Updates |
| Business: | Medi-Cal Managed Care |
Effective March 25, 2024, the Pharmacy and Therapeutics Committee has approved the following changes to the medical benefit.
- Code J1726 – INJECTION, HYDROXYPROGESTERONE CAPROATE, (MAKENA), 10 MG: For Preterm Birth: Requests for hydroxyprogesterone caproate will not be approved for the prevention of pre-term delivery due to FDA withdrawal.
- Code J1729 – INJECTION, HYDROXYPROGESTERONE CAPROATE, (MAKENA), 10 MG: For Preterm Birth: Requests for hydroxyprogesterone caproate will not be approved for the prevention of pre-term delivery due to FDA
withdrawal.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website WWW.HPSJ-MVHP.ORG