California

The Department of Health Care Services (DHCS) posted the following on the Medi-Cal Rx Web Portal. Please note the following items: 1.) On January 1, 2027, the DHCS will transition approximately 2 million Medi-Cal members with Unsatisfactory Immigration Status (UIS) from the Medi-Cal managed care delivery system to Medi-Cal fee-for-service (FFS). Pharmacy providers and prescribers can also review the Policy Guide for Transition of the Unsatisfactory Immigration Status Population from Managed Care to Medi-Cal Fee-for-Service to understand the upcoming changes and prepare for the transition. See "Fee-for-Service Transition Town Hall" for details. 2.) Please review in its entirety the "Update: Include ICD-10-CM Diagnosis Codes on Pharmacy Claims". 

• Fee-for-Service Transition Town Hall – September 30 at 10:00 am PT 

• Ordering, Referring, and Prescribing Enrollment Requirements Town Hall – September 24 at 10:30 am PT 

• Mass Adjustment for Commercialized COVID-19 Vaccines Reimbursement for Impacted Claims with a Date of Service October 1, 2024, through May 16, 2025 

• Now Active: Prior Authorization Policy Updates, Effective September 1, 2026 

• Policy Update for Out-of-State and Out-of-Country Pharmacy Providers, Effective October 1, 2026 

• Medi-Cal Rx Monthly Bulletin for September 

• Now Active: Updates to the Early Refill Policy, Effective August 21, 2026 

• Now Active: MMRV Vaccine Reimbursement for Children Younger Than 4 Years of Age 

• Mass Adjustment for Member Eligibility Data That Impacted Claim Funding for Claims Submitted January 1, 2022, through May 29, 2024 

• Update: Include ICD-10-CM Diagnosis Codes on Pharmacy Claims 

• COB Billing Reminder for GLP-1 Receptor Agonist Drugs 

• State of Emergency Override Activation: Submission Clarification Code 13 

Also in California, the Board of Pharmacy posted the agenda and meeting materials for the Licensing Committee meeting being held on September 23. Of interest, the board will discuss changes in pharmacy law included in AB 1503 (Chapter 196, Statutes of 2025), including updates on implementation activities.  

Finally in California, Medi-Cal is offering a new course titled Medication Therapy Management (MTM) Live Webinar (IO105LW). The course will provide information to registered outpatient pharmacies about certain clinical services, such as reviews of a Medi-Cal member's medications, member education (for example, about how to correctly use medication) and follow-ups with members to ensure treatment efficacy. 

Webinars for the MTM training will be held on the following dates: 

• October 7 at 10:00 am 

• October 27 at 10:00 am 

Providers must register for the webinar through the Medi-Cal Learning Portal (MLP) and select the session they plan to complete to ensure enrollment. 

Note: To register for the course, providers must have internet access and a user profile in the MLP. Google Chrome is the recommended web browser for accessing the MLP. Detailed instructions about the registration process and accessing webinar classes are available on the Outreach & Education page of the Medi-Cal Providers website. 

For additional assistance, contact the Telephone Service Center (TSC) at 1-800-541-5555. 

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