On September 16, 2022, prior authorization (PA) requirements will be reinstated for 11 drug classes for new start medications for Medi-Cal beneficiaries 22 years of age and older.

Earlier this year the California Department of Health Care Services (DHCS) began waiving prior authorizations from the Medi-Cal Rx program to minimize disruptions in patient access to prescription medications that occurred due to challenges with the Medi-Cal Rx transition.

In the first of the three reinstatement phases, claim edits for Drug Utilization Review edits were turned on effective July 22, 2022. DUR Reject Code 88 alerts are triggered by instances such as drug-drug interactions, high dose, early refills, etc. PA requirements will be reinstated for certain drug classes starting September 16, 2022. 

To help physicians understand the phased implementation plan for Medi-Cal Rx, the California Department of Health Care Services (DHCS) has published a Prior Authorization Reinstatement Reference Guide.

Stay up to date with the latest Medi-Cal Rx news by signing up for the Medi-Cal Rx Subscription Service. 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.