Medi-Cal Rx phases out additional grandfathered historical prior auths

April 17, 2023

The California Department of Health Care Services (DHCS) recently initiated Phase III of the Medi-Cal Rx transition, which includes a series of Medi-Cal Rx transition policy lifts for beneficiaries 22 years of age and older.

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 to provide a seamless beneficiary experience. Given systemwide issues in implementing the full pharmacy transition in January 2022, DHCS had extended this transition policy.

On April 21, 2023, Phase III, Lift 2 (P3/L2) will begin—the second in a series of lifts to retire or phase out the grandfathering of these historical prior authorizations. The following 17 Standard Therapeutic Classes (STC) will be impacted with implementation of P3/L2:

  • Contraceptives and Hormones (STC 59-64)
  • Ophthalmic, Nasal, and Otic Preparations (STC 19, 20)
  • Thyroid Agents (STC 55, 57)
  • Topical Anesthetic Agents (STC 45)
  • Dermatologic Agents (STC 93, 95)
  • Biologic Agents (STC 90)
  • Glucocorticoids and Corticotropins (STC 50, 51)
  • Anti-Parkinson’s (STC 9)

For more information about P3/L2, 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. These webinars 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. All webinars will include a live question and answer component.

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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