Coding Corner: What's new in CPT 2018

October 20, 2020

On January 7, 2019, Governor Gavin Newsom issued an executive order aimed at achieving cost savings for drug purchases made by the state. A key component of the order requires the California Department of Health Care Services (DHCS) to transition all Medi-Cal pharmacy services from managed care to fee for service (FFS) by January 1, 2021. The Medi-Cal pharmacy benefits and services administered by DHCS in the FFS delivery system are collectively referred to as “Medi-Cal Rx.”

Medi-Cal Rx will include all pharmacy services billed as a pharmacy claim, including physician administered drugs (PADs). However, PADs billed on medical or institutional claims are excluded from the requirement to transition to Medi-Cal Rx and should not be affected.

Transitioning pharmacy services to FFS will standardize the Medi-Cal pharmacy benefit statewide, under one delivery system and strengthen California’s ability to negotiate state supplemental drug rebates.

Under the Medi-Cal Rx program, physicians will use a secure provider web portal for key prescribing functions, such as:

  • Prior authorization information and submittal instructions
  • Beneficiary eligibility look up
  • Web claims submission, activities, and inquiries

Physicians are encouraged to register early and familiarize themselves with the new portal. For detailed registration and training instructions, click here.

More information on the Medi-Cal Rx transition and the provider portal can be found at https://medi-calrx.dhcs.ca.gov/home


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