February 08, 2023
The California Department of Health Care Services (DHCS) recently announced the list of drugs that will require prior-authorization (PA) under Phase II Wave 2 of the Medi-Cal Rx transition, which is scheduled to start on February 24, 2023.
Phase II, Wave 2 will reinstate PA requirements for 46 additional standard therapeutic classes, including medical supplies, for new start prescriptions for beneficiaries 22 years of age and older. “New starts” are defined as new therapies or medications not previously prescribed to the beneficiary during the 15-month lookback period.
Phase II, Wave 2 will complete the reinstatement of PA requirements for new start prescriptions for beneficiaries 22 years of age and older. Medi-Cal Rx will continue to utilize PA and claims data to allow for grandfathering of previously approved PAs until Phase III of Reinstatement, as announced in the alert.
New start prescriptions for pediatric patients 21 years of age and under continue to be excluded to prevent additional administrative obligations for providers of specialty pediatric services who have been significantly impacted by the transition to Medi-Cal Rx.
For an overview of the remaining phases of the Medi-Cal Rx transition plan, see the DHCS Medi-Cal Rx Reinstatement Spotlight.
DHCS will also be holding Phase II reinstatement webinars via Zoom every Friday at 12 p.m. No registration is required. This month’s webinar will provide information specific to Phase II, Wave 2, including reinstatement of PA requirements for beneficiaries 22 years of age and older and submission of PAs in advance of the retirement of the transition policy.
To receive the latest news, alerts and bulletins on Medi-Cal Rx, including the Reinstatement Spotlight published each Friday, sign up for the subscription service here.
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.
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