A California federal court dismissed PCMA’s challenge to California’s law SB 41 imposing fiduciary duties on PBMs.  PCMA sued California Attorney General Rob Bonta in the US District Court for the Central District of California in January, arguing that this law interferes with self-funded health plans that are federally regulated under ERISA. Bonta argued that PCMA had not demonstrated specifics on how the law would negatively impact their daily business practices and that “other than regulating prohibited transactions, ERISA has nothing to say about plan-service provider relationships.”  Judge Otis D. Wright, II, agreed, saying PCMA’s arguments only amounted to an “abstract theory” of injury by failing to identify specific contract provisions or operational changes PBMs would have to undergo.  “Without such allegations, the Court is left to guess what conduct the statute requires and what burdens it imposes,” he wrote in his opinion dated July 24.  The judge allowed PCMA to file an amended complaint, which the group said in a statement it plans to do. PCMA Counsel Michael Kimberly noted that Wright “recognized that compliance costs and changes to business operations are concrete injuries.” If Judge Wright finds that PCMA’s amended complaint properly states a concrete injury, the case will move forward. 

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

The Department of Health Care Services (DHCS) will soon begin revalidating pharmacy providers in accordance with federal regulations.

Enrolled pharmacies that have not submitted an application in the past year will soon receive a paper notice sent via USPS. If the provider has reported different service, pay-to and mailing addresses, a copy of the notice will be sent to each unique address. This notice will require the pharmacy to respond within 35 calendar days and confirm that they intend to continue participating in the Medi-Cal program. To facilitate the response, the notices will include a QR code that may be used to provide the confirmation. Failure to respond to the notice within 35 days will result in deactivation from the Medi-Cal program.

After completing this first step and confirming that they intend to continue to participate, providers will receive another paper notice with instructions for completing the next part of the revalidation process. This second step will include using the Provider Application and Validation for Enrollment (PAVE) system to complete a revalidation application. Providers will have 70 calendar days from the date of this notice to submit a complete revalidation application. Providers should not begin the application in PAVE before receiving the second notice – applications initiated before receiving the second notice will not be accepted.

In most cases, the revalidation will be separately completed for each location, and each location will receive unique notices and will require unique responses. Chain pharmacies will complete a slightly different process.

For more information, please contact Jenny Tudesko, Assistant Division Chief, Provider Enrollment Division, Department of Health Care Services

Also in California, attention: DHCS Town Hall Webinar on July 30 to Discuss Medi-Cal Provider Enrollment Requirements

• Who: Department of Health Care Services (DHCS)
• What: Town Hall Webinar
• When: July 30, 2026; 9:30am – 11:00am PDT
• Advance registration is required – register now.

The State Board of Pharmacy wishes to advise licensees and other stakeholders that DHCS will host a town hall webinar on July 30 to explain Ordering, Referring and Prescribing (ORP) enrollment requirements for claims across both pharmacy (Medi-Cal Rx) and medical (CA-MMIS) billing systems.

Federal law requires providers who order, refer or prescribe services for Medi-Cal members to be enrolled in Medi-Cal and identified on claims using a valid Type 1 (Individual) National Provider Identifier (NPI). The webinar will explain this requirement, clarify what prescribers and providers must do to achieve or stay in compliance, and gather questions from stakeholders.

ORP enrollment requirements may apply to you – Board licensees are encouraged to register and attend to learn more about these important changes.

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

REMINDER: Medi-Cal Rx appreciates your continued partnership and support in ensuring the continuity of care for members. Medi-Cal staff are requesting stakeholder feedback regarding the services provided by the Resolution Team (also known as the Special Population and Managed Care Plan Clinical Liaison Team). Participation in the Stakeholder Survey for the Resolution Team will help with efforts for continuous process and quality improvement. Please submit your responses no later than July 19.

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