November 02, 2021
On January 1, 2022, the California Department of Health Care Services (DHCS) will transition all Medi-Cal pharmacy services from managed care to fee-for-service (FFS). The Medi-Cal pharmacy benefits and services administered by DHCS in the FFS delivery system is collectively referred to as “Medi-Cal Rx.” The goal of Medi-Cal Rx is to standardize the pharmacy benefit under one delivery system and improve access to pharmacy services with a network that includes a large majority of the state’s pharmacies.
Starting on January 1, 2022, providers will use the secure Medi-Cal Rx portal to access the following systems:
- Prior Authorizations
- Secure Chat and Messaging
- Beneficiary Eligibility Lookup
- Web and Batch Claims Submission
- Education and Outreach Calendar
The California Medical Association (CMA) encourages physicians—particularly those who currently prescribe medications for Medi-Cal patients—to register for the secure Medi-Cal Rx Provider Portal as soon as possible and ensure you are prepared for the upcoming transition to avoid any disruptions in patient care.
PLEASE NOTE: If you are a prescriber and use CoverMyMeds® or the fax system to submit prior authorizations today, there will be no change for you as of January 1. In addition, if your EHR is compatible and configured with CoverMyMeds®, you will continue to do business as usual.
Starting January 1, 2022, pharmacies and prescribers can submit prior authorizations using one of the five channels outlined in the DHCS Medi-Cal Rx Options for PA Submission Guide. (Also see DHCS’s Five Ways to Submit a Prior Authorization Flyer for an overview.)
The Medi-Cal Rx Transition Policy also includes “grandfathering” for previously approved prior-authorization and a 180-day period where DHCS will not require prior authorizations for existing prescriptions in order to provide a seamless beneficiary experience.
Medi-Cal Rx Readiness Survey
DHCS is asking for feedback on how physicians currently conduct business for Medi-Cal pharmacy services through its Medi-Cal Rx “readiness” survey. The results will be used to tailor educational resources and training offerings to ensure practices are prepared for the transition to Medi-Cal Rx.
For More Information
The Medi-Cal Rx YouTube Channel offers training videos, including a video on the transition and the resources that directly impact pharmacy providers and prescribers. DHCS also offers live, instructor-led trainings and Office Hour Luncheon Sessions every Monday-Friday, from 12 to 1 p.m. (excluding holidays).
Be sure to subscribe to the Medi-Cal Rx Subscription Service (MCRxSS) to stay up to date with the latest Medi-Cal Rx news. For questions, please contact the Medi-Cal Rx Customer Service Center at (800) 977-2273, available 24 hours a day, 365 days a year or email MediCalRxEducationOutreach@magellanhealth.com.
CMA also recently co-hosted a webinar with DHCS on the Medi-Cal Rx transition. That webinar is now available for on-demand viewing. It is available free to all interested parties.