Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) will continue to support members and our valued providers to maximize vaccine adoption and administration. Health Plan remains responsible for providing case management and care coordination for members.
Vaccination and Test Sites: If your practice is not providing vaccinations to members, please direct them to their local pharmacy or have the member contact Health Plan for assistance.
Do your Health Plan patients need transportation to test or vaccination sites? They can call Health Plan at 888-936-7526 TTY 711 to set up transportation to/from their vaccine appointment.
Outpatient COVID-19 Pre-exposure Prophylaxis and Treatment Options
Billing Options for COVID-19 Medications/Vaccines or Tests
| Pharmacy Benefit (Billed via Pharmacy) |
Medical Benefit (Billed via medical claims) |
||
| Medication/Vaccine* or Test | Medi-Cal Rx | Medi-Cal FFS | HPSJ |
| Paxlovid (nirmatrevir/ritonavir) | Yes | No | No |
| Lagevrio (molnupiravir) | Yes | No | No |
| Veklury (remdesivir) | Yes | Yes | Yes |
| COVID-19 Vaccines | Yes | Yes | Yes |
| Prescribed in-home testing kits | Yes | No | Yes |
| Antibody Testing | No | No | Yes |
| Vaccine administration fee when performed at the provider’s office or pharmacy | No | Yes | Yes |
*All medications/vaccines are federally covered at this time and free to providers/pharmacies, therefore providers/pharmacies will only be reimbursed for the professional dispensing fee via Medi-Cal Fee-For-Service/Medi-Cal Rx.
Provider Alerts
Pharmacy Updates
Posted on March 25th, 2020 and last modified on September 5th, 2024.
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