Medi-Cal Rx temporarily removes prior auth requirements for most drugs

February 08, 2022
Area(s) of Interest: Payor Issues and Reimbursement 

On January 1, 2022, the California Department of Health Care Services (DHCS) transitioned 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.”

According to a notice issued on February 6, 2022, to provide a seamless beneficiary experience and minimize disruptions in patient access to prescription medications during the Medi-Cal Rx transition, DHCS has revised the Medi-Cal RX prior authorization policy effective immediately and retroactive to January 1, 2022.

Effective immediately, the prior authorization requirement will temporarily be removed for all drugs, except for the following: 

  1. Psychostimulants – Antidepressants
  2. Opioid Analgesics
  3. Ataractics – Tranquillizers (including antipsychotics and benzodiazepines)
  4. Certain excluded products and for children under the age of 21

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). 

CMA recommends practices subscribe to the Medi-Cal Rx Subscription Service 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 available free to all interested parties and available for on-demand viewing.

Additional Resources

If your practice is experiencing problems billing for drugs under the Medi-Cal Rx program, please contact the California Medical Association at (800) 786-4262 or economicservices@cmadocs.org.


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