Reminder: Medi-Cal Rx to reinstate grandfathered prior auth for some drugs on March 24

March 17, 2023

Physicians are reminded that the California Department of Health Care Services (DHCS) will initiate the first of a series of Medi-Cal Rx transition policy lifts for beneficiaries 22 years of age and older starting March 24, 2023.

The original Medi-Cal Rx Transition Policy included “grandfathering” previously approved prior-authorizations and a 180-day period where DHCS would not require prior authorizations for existing prescriptions in order to provide a seamless beneficiary experience. Given systemwide issues in implementing the full pharmacy transition in January 2022, DHCS extended this transition policy until now.

In Phase III, Lift 1 (P3/L1), DHCS will lift the transition policy that overrode NCPDP Reject Code 75 – Prior Authorization Required for beneficiaries 22 and older. To see which standard therapeutic classes will be impacted by the first transition lift, click here.

Questions about the Medi-Cal Rx reinstatement? DHCS is hosting live webinars via Zoom every Friday at 12 p.m. No registration is required. This webinar will provide information specific to prior authorization requirements for beneficiaries 22 years of age and older, as well as discussion about the submission of prior authorizations in advance of the retirement of the Transition Policy. These Friday webinars will continue through the completion of reinstatement to provide relevant information in advance of each upcoming phase.

If you are unable to join the live webinars, they will be available for on-demand playback on the Medi-Cal Rx YouTube channel.

Stay up to date with all that is happening with Medi-Cal Rx by signing up for the Medi-Cal Rx Subscription Service.

Practices experiencing challenges with Medi-Cal Rx reinstatement are encouraged to contact the California Medical Association at (800) 786-4262 or economicservices@cmadocs.org.


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