7/6/22, 10:41 AM
3. Antiretroviral Ibalizumab-uiyk Injection Available for Managed Care Plans
Medi-Cal Update
Part 1 - Program and Eligibility | June 2022
3. Antiretroviral Ibalizumab-uiyk Injection Available for Managed Care
Plans
Effective retroactively for dates of service on or after March 6, 2018, HCPCS code J1746 (injection, ibalizumab-uiyk, 10
mcg) is a noncapitated service for Managed Care Plans (MCPs) except for the following Health Care Plans (HCPs):
Cal MediConnect
Program of All-Inclusive Care for the Elderly (PACE)
Senior Care Action Network (SCAN)
Health Plan of San Mateo
CalOptima
HCPCS code J1746 is used to treat multidrug resistant HIV-1 in heavily treatment-experienced adults failing their current
antiretroviral regimen.
lbalizumab-uiyk was available as a noncapitated·service for AIDS Healthcare Centers - Los Angeles for dates of service
from March 6, 2018, to June 30, 2019.
Providers are encouraged to check the Medi-Cal website regularly for updates to the current list of contract drugs and MCP
policy.
Provider Manual(s) Updates
Provider Manual(s)
Page(s) Updated
Part 1
mcp cohs (6)
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