November 17, 2020
Area(s) of Interest: Public Payors
In an effort to ensure a smooth transition amid the ongoing COVID-19 pandemic, the California Department of Health Care Services (DHCS) announced its decision to delay the transition to Medi-Cal Rx by three months, until April 1, 2021. In the interim, all current prescription drug service processes and protocols, both effectuated by DHCS and Medi-Cal managed care plans, will remain unchanged and in place until Medi-Cal Rx launches.
According to DHCS, the additional months will allow more time to develop safeguards to ensure a smoother and more complete transition of prescription drug services for Medi-Cal’s nearly 13 million beneficiaries during the public health emergency. The notice states the additional time will provide more opportunities for Medi-Cal providers, beneficiaries and others to become familiarize themselves with the new Medi-Cal Rx policies and processes, and will allow additional targeted stakeholder engagement and outreach efforts.
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 lookup
- Web claims submission, activities and inquiries
With the additional time, 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 personal identification number (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.
More information on the Medi-Cal Rx transition and the provider portal can be found at medi-calrx.dhcs.ca.gov/home.