Medi-Cal Rx to reinstate prior auth for remaining drug classes

December 13, 2022

The California Department of Health Care Services (DHCS) recently announced that phase 2 of the Medi-Cal Rx transition will begin in January 2023. In Phase II—which will be implemented in two waves—Medi-Cal Rx prescribers will again be required to submit prior authorizations (PAs) for the remaining drug classes.

DHCS announced during a stakeholder call last week that Phase II Wave 1, which starts on January 20, 2023, will include new start prescriptions in 39 drug classes for beneficiaries 22 and older (the list of drugs included in Phase II Wave 1 can be found on the last page of the slides that were shared during the stakeholder call). The remaining 21 drug classes will be included in Wave 2, which will start on February 24, 2023. The list of affected drug classes has not yet been published.

New start prescriptions for pediatric patients 21 years of age and under continue to be excluded to prevent additional administrative obligations for providers of specialty pediatric services who have been significantly impacted by the transition to Medi-Cal Rx.

For more information about the phased implementation plan for Medi-Cal Rx, see the DHCS 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.



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