The member identification number will be the CIN number. This is a number assigned by the state and is not the social security number.

The member identification number will be the CIN number. This number is assigned by the state and is not the social security number. Kern Family Health Care (KHS Medi-Cal) BIN 600428 PCN 04970000 Pt. Number is CIN Number Formulary OTC's Covered Formulary Formulary Prenatal Vitamins Covered (OTC included) Formulary Contraceptives Covered No copayments TAR's allowed for OTC and legend

The Pharmacy and Therapeutics Committee is composed of Physician and Pharmacist community providers as well as staff from Kern Health Systems. We have primary care providers, specialty physicians, and community based pharmacists (both chain and independent). Meetings are usually held quarterly. Issues you feel could improve our formularies or systems can be forwarded to the Director of Pharmacy at the plan offices, 9700 Stockdale Highway, Bakersfield, CA, 93311, phone 661-664-5101, fax 661-664-5191. Input from providers is welcomed. If you would like to serve on the Pharmacy & Therapeutics Committee please advise our Director of Pharmacy or Medical Director.

Requests for non-formulary medications or supplies may be submitted online (preferred), or state form 61-211. Please include the CIN number, medication failures, and non-formulary item requested as well as information on the patient. One drug per form please. Fax the information to Kern Health Systems at 661-664-5191. You may telephone Kern Health Systems about non-formulary requests but State Law does require information to be submitted (electronic or faxed).

Providers are discouraged from providing samples; however, if samples are given to the member, the entire course of therapy must be covered by the samples in accordance to Policy 2.24, Pharmaceutical Guidelines. Medications provided as samples do not establish continuity precedent; and, therefore do not obligate coverage by KHS.

Barring any medically adverse responses from the member, the trial period of a medication shall be determined per the recommended dosing titration guidelines presented to the FDA.

During weekends, holidays, and non-business hours a pharmacy may choose to dispense enough medication (72 hours supply maximum) as an emergency supply to the member until the next working day, at the dispensing pharmacist's discretion according to pharmacy policy and procedures. If the medication is not on the Plan Formulary, a request must be submitted to payment processing stating the emergency and medication dispensed. TAR approval is not needed for reimbursement before dispensing of 72 hour emergency supply of non-formulary drugs.

If a medication is available as an AB rated generic, then the brand name version will become non-Formulary. If a generic brand becomes available during a patient's treatment, the patient will be expected to switch to the generic brand and must fail the generic brand prior to KHS granting authorization for the brand name. Providers with patients having untoward effects from a generic brand will be required to submit a completed FDA MedWatch form to KHS as part of the authorization for a request to allow a brand name version instead of a generic brand.

If a representative would like something to be considered by the P&T committee they need to submit the request and supporting documents to KHS. KHS permits contact from the pharmaceutical industry only in written form. All correspondence is to be directed to the KHS Pharmacy Department. Material may be submitted by fax, US mail, or via e-mail. Unless specifically requested by KHS, face to face presentations, phone solicitations or any other means of communication are not allowed. KHS values the P&T committee members time and effort dedicated to the plan and its members. They should not be contacted for committee considerations and requests.

All medications listed in the KHS Formulary are Tier 1 and are covered if there is no restriction or the restriction(s) is/are met. Any medication authorized through the TAR process is also considered Tier 1 for coverage purposes. Please note that claims may reject at the pharmacy point of service for reasons not listed in the KHS Formulary, such as drug interactions and therapeutic duplications.

Please see Formulary section for IV solution categories covered. KHS covers the stated infused agents in the categories listed. These are typically covered as part of a per diem case rate.

Medications listed in the KHS formulary are identified by the stated formulations and strengths. A drug may have only certain strengths or formulations covered. Non stated formulations would require a TAR.

These medications are carved out by Medi-Cal as stated in the Medi-Cal bulletin. The prescriptions for any of the carved out medications are transmitted to Medi-Cal. If the claim for the listed drugs is rejected by EDS for a Kern Family Health Care patient with a message stating to bill the primary insurance, it is likely the patient has insurance in addition to Kern Health Systems. Some prescriptions may require a TAR from Medi-Cal.

Click on a section name to view a list of the carve out drugs in that section.

• Psychotherapeutic Agents
• Alcohol, Heroin Detoxification and Dependency Treatement Drugs
• Antiviral Agents