November 09, 2020
Physicians who write prescriptions for Medi-Cal patients must sign up for the state’s new Medi-Cal Rx portal before Jan. 1, 2021, as the state works to improve access to pharmacy benefits and standardize the Medi-Cal pharmacy benefit statewide.
Physicians are encouraged to start the registration process as soon as possible, to ensure their ability to prescribe for Medi-Cal patients is not interrupted. The first step in the registration process is to request a PIN, which will be sent via mail to the address on record with Medi-Cal. The letter with the PIN can take up to 10 days to arrive.
Prescribers will also need training on the new portal, which is offered for free by the California Department of Health Care Services (DHCS). For detailed registration and training instructions, click here.
As one of his first acts as 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 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.
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
More information on the Medi-Cal Rx transition and the provider portal can be found at medi-calrx.dhcs.ca.gov/home.