ACCESS TO BLEEDING DISORDER MEDICATION

In California

State-level regulations are a critical factor in determining access to treatment and shaping advocacy efforts. These policies can either support patients or limit their ability to receive necessary care. Read on to learn more about the regulatory landscape in California and how advocacy is affected.

See more California-specific topics:

Medi-Cal Members

  • Managed care plans (MCPs) and county behavioral health plans (BHPs) share responsibility for coordinating care to meet the physical and behavioral health needs of Medi-Cal members.

    Source:

    • Medi-Cal Behavioral Health – Policy Division. “Managed care plans (MCPs) and county behavioral health plans (BHPs) share responsibility for coordinating care to meet the physical and behavioral health needs of Medi-Cal members.”

  • Step 1: Ask about their current policy
    “Can you tell me whether your facility allows patients to bring in and use previously prescribed and dispensed medications from home?”

    “Just so you’re aware, [patient’s name] is a Medi-Cal beneficiary and Medi-Cal Managed Care plans and behavioral health plans share responsibility for coordinating care to meet the physical and behavioral needs of beneficiaries, such as access to their required injection/infusion medication.”

    If the facility allows home medications:

    “That’s great to hear. In that case, our patient may be able to bring their bleeding disorder medication with them at the time of admission.

    This approach helps avoid delays in treatment and can reduce the burden on your team by eliminating the need to navigate unfamiliar procurement processes.”

    If the facility does not allow home medications or doesn’t have a clear policy offer to help them create such a policy:

    “Thank you for clarifying. If your facility doesn’t currently have a home medication policy in place, we’d be happy to share a sample document that you can use as a starting point for crafting a home medication policy that works for you facility."

    Step 2: Offer support through specialty pharmacy coordination
    “If bringing medication from home isn’t possible, our team can help in other ways. For example, we can work with you to:

    • Identify local specialty pharmacies that are able to deliver the prescribed bleeding disorder medication directly to your facility, and

    • Support communication and coordination between the pharmacy and your clinical or administrative staff to make the process as smooth as possible.”

    Step 3: Explore alternate care pathways if needed

    “If your facility is unable to allow home medications and cannot accept direct delivery from a specialty pharmacy, we can work together to explore other options to ensure the patient receives their treatment as scheduled. This may include:

    • Arranging for the patient to receive their infusion or injection at a nearby Hemophilia Treatment Center (HTC), or

    • Coordinating with a local infusion center or emergency department (ED) for scheduled doses during their stay.”

  • Send the following to the facility:

    • Access to Bleeding Disorder Medication: Personalize this email template to support access to bleeding disorder medication. For Medi-Cal members, add the following:

      “Just so you’re aware, [patient’s name] is a Medi-Cal beneficiary and Medi-Cal Managed Care plans and Behavioral health plans share responsibility for coordinating care to meet the physical and behavioral needs of beneficiaries, such as access to their required injection/infusion medication.”

Non-Medical Substance Use Disorder Facilities

  • Per California Code of Regulations, SUD facilities are required to ensure that residents receive necessary information about and/or referrals to needed medical services. This includes access to prescribed infusion and injection medication.

    California Code of Regulations, Title 9, Section 10505 states, “Except for facilities operated by a State agency, no person, firm, partnership, association, corporation, county, city, public agency or other governmental entity shall operate, establish, manage, conduct, or maintain a facility which provides 24-hour non-medical, residential, alcoholism or drug abuse recovery or treatment services to adults without first obtaining a current, valid license from the Department.” The term “non-medical” specifically precludes licensed facilities from acting as a medical facility or offering medical services.

    Sources:

  • Step 1: Ask about their current policy
    “Can you tell me whether your facility allows patients to bring in and use previously prescribed and dispensed medications from home?”

    “Just so you’re aware, per California Code of Regulations, non-medical SUD facilities are required to ensure that residents receive referrals to needed medical services, such as access to prescribed infusion and injection medications.”

    If the facility allows home medications:

    “That’s great to hear. In that case, our patient may be able to bring their bleeding disorder medication with them at the time of admission.

    This approach helps avoid delays in treatment and can reduce the burden on your team by eliminating the need to navigate unfamiliar procurement processes.”

    If the facility does not allow home medications or doesn’t have a clear policy offer to help them create such a policy:

    “Thank you for clarifying. If your facility doesn’t currently have a home medication policy in place, we’d be happy to share a sample document that you can use as a starting point for crafting a home medication policy that works for you facility."

    Step 2: Offer support through specialty pharmacy coordination
    “If bringing medication from home isn’t possible, our team can help in other ways. For example, we can work with you to:

    • Identify local specialty pharmacies that are able to deliver the prescribed bleeding disorder medication directly to your facility, and

    • Support communication and coordination between the pharmacy and your clinical or administrative staff to make the process as smooth as possible.”

    Step 3: Explore alternate care pathways if needed

    “If your facility is unable to allow home medications and cannot accept direct delivery from a specialty pharmacy, we can work together to explore other options to ensure the patient receives their treatment as scheduled. This may include:

    • Arranging for the patient to receive their infusion or injection at a nearby Hemophilia Treatment Center (HTC), or

    • Coordinating with a local infusion center or emergency department (ED) for scheduled doses during their stay.”

  • Send the following to the facility: