Editor’s note: this information was provided by the California Department of Health Care Services (DHCS). Visit the DHCS website at https://www.dhcs.ca.gov/.
As of January 1, 2022, the Medi-Cal pharmacy benefit will transition from the current Medi-Cal managed care delivery system to Fee-For-Service under Medi-Cal Rx. All benefits that are billed on a pharmacy claim will be transitioned to Medi-Cal Rx and all pharmacy Prior Authorizations will be reviewed by Medi-Cal Rx starting on January 1, 2022. This transition is a critical step for the success of the California Advancing and Innovating Medi-Cal (CalAIM) initiatives proposed by the California Department of Health Care Services. Medi-Cal Rx will:
- Standardize the Medi-Cal pharmacy benefit under one statewide delivery system. This means that no matter what county a person lives in, the same access to their prescriptions is possible.
- Improve access to pharmacy services.
- Centralize pharmacy policy, transactions, and reimbursements, leading to greater efficiency for pharmacies, prescribers, and the Medi-Cal program.
To prepare for Medi-Cal Rx, please visit the Medi-Cal Rx Education & Outreach page on the Medi-Cal Rx Web Portal to take advantage of training opportunities and informative materials. The Medi-Cal Rx YouTube Channel also offers training videos, including one on the transition and the resources that directly impact Medi-Cal pharmacy providers and prescribers. Also offered are live, instructor-led trainings, or Office Hour Luncheon Session available Monday-Friday, 12 p.m. to 1 p.m. PST (excluding holidays). Please note: If you are a prescriber and use CoverMyMeds® or the fax system to submit Prior Authorizations today, there is no change for you as of January 1. In addition, if your EHR is compatible and configured with CoverMyMeds®, you will continue to do business as usual.
Medi-Cal Rx is designed to improve your experience with Medi-Cal and includes, among other things, a uniform and searchable Contract Drug List, as well as a 24-hour a day, 365 days a year customer service center, available to assist prescribers, pharmacy providers, beneficiaries, managed care plans and others.
Please visit the Medi-Cal Rx Provider Portal Forms & Information page to find these available resources:
Be sure to subscribe to the Medi-Cal Rx Subscription Service (MCRxSS) to stay up to date with the latest Medi-Cal Rx news. For questions, please contact the Medi-Cal Rx Customer Service Center at 1-800-977-2273, available 24 hours a day, 365 days a year or via email at MediCalRxEducationOutreach@magellanhealth.com.