Medi-Cal Rx enables extended duration prior auths for certain maintenance meds

April 17, 2023

The California Department of Health Care Services (DHCS) recently initiated a series of Medi-Cal Rx transition policy lifts for beneficiaries 22 years of age and older. These lifts are part of a multi-phase implementation of prior authorization policies that were suspended during the Medi-Cal Rx transition.

To further reduce administrative burdens during the transition, while ensuring continued medication safety for beneficiaries, DHCS recently enabled extended duration/multi-year prior authorizations for up to five years for certain maintenance medications used for chronic conditions that require prior authorizations. (This only applies to beneficiaries 22 years of age and older at this time.)

For maintenance medications with approved prior authorizations or paid claims history within the past 15 months, no action is required. These prescriptions will be automatically extended. New prior authorization requests for maintenance medications will automatically be considered for extended duration as part of the review process.

For more information, click here.


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