Medi-Cal Rx phases out 46 more grandfathered historical prior auths

May 24, 2023

The California Department of Health Care Services (DHCS) recently initiated Phase III, Lift 4 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 June 23, 2023, Phase III, Lift 4 (P3/L4) will begin—the fourth in a series of lifts to phase out the grandfathering of these historical prior authorizations. A total of 46 Standard Therapeutic Classes (STC) will once again require prior authorization with implementation of P3/L4.

For more information about P3/L4, click here.




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