On January 1, 2022, the California Department of Health Care Services (DHCS) will transition all Medi-Cal pharmacy services from managed care to fee-for-service (FFS). The Medi-Cal pharmacy benefits and services administered by DHCS in the FFS delivery system is collectively referred to as “Medi-Cal Rx.” The goal of Medi-Cal Rx is to standardize the pharmacy benefit under one delivery system and improve access to pharmacy services with a network that includes a large majority of the state’s pharmacies.

Starting on January 1, 2022, providers will use the secure Medi-Cal Rx portal to access the following systems:

• Prior Authorizations
• Secure Chat and Messaging
• Beneficiary Eligibility Lookup
• Web and Batch Claims Submission
• Education and Outreach Calendar

The California Medical Association (CMA) encourages physicians—particularly those who currently prescribe medications for Medi-Cal patients—to register for the secure Medi-Cal Rx Provider Portal as soon as possible and ensure you are prepared for the upcoming transition to avoid any disruptions in patient care.

PLEASE NOTE: If you are a prescriber and use CoverMyMeds^® or the fax system to submit prior authorizations today, there will be 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.

Prior Authorizations

Starting January 1, 2022, pharmacies and prescribers can submit prior authorizations using one of the five channels outlined in the DHCS Medi-Cal Rx Options for PA Submission Guide. (Also see DHCS’s Five Ways to Submit a Prior Authorization Flyer for an overview.)

The Medi-Cal Rx Transition Policy also includes “grandfathering” for previously approved prior-authorization and a 180-day period where DHCS will not require prior authorizations for existing prescriptions in order to provide a seamless beneficiary experience.  

Medi-Cal Rx Readiness Survey

DHCS is asking for feedback on how physicians currently conduct business for Medi-Cal pharmacy services through its Medi-Cal Rx “readiness” survey. The results will be used to tailor educational resources and training offerings to ensure practices are prepared for the transition to Medi-Cal Rx.

For More Information

• Medi-Cal Rx Provider Communications
• Medi-Cal Rx Frequently Asked Questions
• Medi-Cal Rx Contract Drugs List
• Five Ways to Submit a Prior Authorization Flyer 
• Medi-Cal Rx Prior Authorization Job Aid 

The Medi-Cal Rx YouTube Channel offers training videos, including a video on the transition and the resources that directly impact pharmacy providers and prescribers. DHCS also offers live, instructor-led trainings and Office Hour Luncheon Sessions every Monday-Friday, from 12 to 1 p.m. (excluding holidays). 

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 (800) 977-2273, available 24 hours a day, 365 days a year or email MediCalRxEducationOutreach@magellanhealth.com.

CMA also recently co-hosted a webinar with DHCS on the Medi-Cal Rx transition. That webinar is now available for on-demand viewing. It is available free to all interested parties.