Medi-Cal: reimbursement: blood factors.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law provides for a schedule of benefits covered by the Medi-Cal program, including the purchase of prescribed drugs subject to the Medi-Cal list of contract drugs and utilization controls. Existing law authorizes the department to enter into contracts with manufacturers of drugs, to maintain a list of contract drugs, including blood factors, and to require pharmaceutical manufacturers to provide various rebates to the state. Existing law requires the reimbursement for blood factors to be by national drug code number and to not exceed 120% of the average sales price of the last quarter reported. This bill would instead require the reimbursement for blood factors to be the lower of the wholesale acquisition cost, 120% of the average sales price of the last quarter reported, or the actual acquisition cost for the drug plus a professional dispensing fee of $0.14 per unit. The bill would define those costs and fees for these purposes.