Pursuant to the enacted 2025-26 State Budget, the Department of Health Care Services (DHCS) will be implementing Medi-Cal Rx policy updates, effective January 1, 2026. These changes are intended to reduce pharmacy spending, improve program integrity, and ensure continued, equitable access to quality pharmacy benefits and services. Also, effective November 1, 2025, the coordination of benefits (COB) claims submission process will be updated for Medicare. See Upcoming Changes to Medi-Cal Rx for background information.
Also in California, the Department of Health Care Service posted the following on the Medi-Cal Rx Web Portal. Please review the “90-day Countdown: Upcoming Changes to Medi-Cal Rx” alert. Note changes are effective January 1, 2026. Please see the alert for details.
Also in California, the Health & Human Services Agency (CalHHS) launched a new webinar series focused on recent federal policy changes in health and human services and how California is responding to ensure continued access to care. The first webinar in the series addressed vaccine access and guidance, a timely topic as the state enters respiratory virus season. A full recording of the webinar and presentation slides are available for those who were unable to attend. The webinar featured insights from CalHHS Secretary Kim Johnson, Department of Public Health (CDPH) Director and State Public Health Officer Dr. Erica Pan and Department of Managed Health Care Director Mary Watanabe. Topics covered included public health updates, health plan coverage requirements and Medi-Cal vaccine coverage.
Under updated California law, health plans and insurance companies regulated by the state, including Medi-Cal, are required to continue covering routine immunizations recommended by the CDPH. This includes vaccines for flu, COVID-19 and RSV. Californians are encouraged to review CDPH’s vaccine recommendations and check with their health plan or insurer if they have questions about coverage. To schedule a vaccine appointment, individuals can contact their health care provider, visit a local pharmacy, or go to MyTurn.ca.gov.
Finally in California, on September 26, Gov. Gavin Newsom (D) signed AB 260 (Chapter 136, Statutes of 2025), legislation related to sexual and reproductive health care. NACDS is sharing this as information for members as there are provisions in the newly enacted law related to “pharmacists”.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.