California

The Department of Health Care Service posted the following on the Medi-Cal Rx Web Portal. Please review the numerous changes to Medi-Cal Rx effective January 1, 2026. 

• Reminder: Include ICD-10-CM Diagnoses Codes on Pharmacy Claims 

• Changes to Medi-Cal Rx, Effective January 1, 2026  

• Upcoming Pharmacy Professional Dispensing Fee Provider Self-Attestation 

• Restricted Pharmacy Benefit Coverage for Emergency and/or Pregnancy-Related Services for Select Medi-Cal Aid Codes, Effective January 1, 2026 

• Medi-Cal Rx Monthly Bulletin for January 

• State of Emergency Override Activation: Submission Clarification Code 13 

• Mass Adjustment for Vaccines Reimbursement for Members 19 Years of Age and Older for Impacted Claims with a Date of Service January 1, 2024, through March 31, 2024 

• Mass Adjustment for Enteral Nutrition Products for Impacted Claims Reprocessed on May 29, 2024 

• Restricted Pharmacy Benefit Coverage for Emergency and/or Pregnancy-Related Services for Select Medi-Cal Aid Codes, Effective January 1, 2026 

• GLP-1 Coverage Considerations 

• Update: Medi-Cal Rx Physician Administered Drug Temporary Policy Reinstatement 

Also in California, the Board of Pharmacy published a Special Edition of The Script newsletter  dedicated to AB 1503, the Sunset Measure for the Board of Pharmacy. This Special Edition focuses on: 

• Standard of Care 

• Nonresident Pharmacies 

• Inspection of Nonresident Pharmacies 

• Establishing Pharmacy Technician Advisory Committee 

• Self-Assessment Process  

• Define Pharmacy Technician Trainee 

• Define Pharmacist 

• Title Change to Advanced Pharmacist Practitioners 

• Enforcing Pharmacy Law 

• Pharmacist-in-Charge, Staffing 

• COVID-19 Oral Therapeutics 

• Emergency Refill Provisions 

• Dispensing Hormone Therapy 

• Pharmacy Records and Digital Conversion 

• Ownership Prohibition 

• Reporting to CAMER 

• Chain Community Pharmacy Employee Notice 

• Pharmacy Technician Duties 

• High Risk Patients 

• Retired Pharmacists License 

• Mail Order Pharmacies 

• Fees: Medically Underserved Area 

Also in California, the Board of Pharmacy issued a notice to licensees to renew registration with the Institute for Safe Medication Practices (ISMP) for the California Medication Error Reporting (CAMER) System by January 31. Business and Professions Code (BPC) section 4113.1 establishes requirements for a community pharmacy to report medication errors to an entity approved by the Board. 

Finally in California, the Department of Managed Health Care issued All Plan Letter RE: APL 25-020 (OPL [Office of Plan Licensing]) – Newly Enacted Statutes Impacting Health Plans (2025 Legislative Session). Please review information related to AB 116 and SB 41, PBM reforms enacted in 2025. 

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.