March 08, 2022
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.”
On February 6, 2022, DHCS revised the Medi-Cal RX prior authorization policy retroactive to January 1, 2022, temporarily removing the prior authorization requirement for most drugs. Although the initial policy change did NOT apply to psychostimulants or antidepressants, DHCS announced today it would temporarily waive the prior authorization for that category of drugs.
The only categories still requiring prior authorization are:
- Opioid Analgesics
- Ataractics – Tranquillizers (including antipsychotics and benzodiazepines)
- 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.
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 firstname.lastname@example.org.