Medi-Cal Rx was implemented on January 1, 2021. The Monthly Bulletin for January has been posted to the Medi-Cal Rx Web Portal.  

Also in California, Medi-Cal Rx issued a Share of Cost bulletin to clarify that the process will be unchanged by the implementation of Medi-Cal Rx.  

Also in California, Medi-Cal Rx issued an alert announcing that reject code 16 M/I Prescription/Service Reference Number is temporarily suspended. Pharmacy providers may resubmit claims if they receive this rejection.  

Also in California, the Board of Pharmacy published its January 2022 monthly update. Note the last item about pharmacy laws effective in 2022. 

Finally, the Board of Pharmacy also published a reminder of the new e-prescribing laws effective January 1, 2022. 

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

The Department of Health Care Services continues to post and publish information to prepare pharmacy providers for the implementation of Medi-Cal Rx effective January 1, 2022.  See “Medi-Cal Rx begins January 1st, are you ready?”. Note: use this link Office Hour Luncheon Session ,which is only available Monday-Friday, 12 p.m. to 1 p.m. PST (excluding holidays).  Please note the prior authorization process and other essential information. Lastly, the Medi-Cal Rx customer service number is 1-800-977-2273 and is available 24 hours a day, 365 days a year after January 1, 2022. The Customer Service Center published a list of Main Menu Prompt Options. 

Also in California, the Medi-Cal Rx Web Portal has been updated with the following.  Note: Medi-Cal Rx will be implemented effective January 1, 2022.  

• Countdown to Go-Live – Have You Reviewed the Medi-Cal Rx Pharmacy Transition Policy? 
• Medi-Cal Rx Electronic Claims Agreement 

Also in California, the Department of Health Care Services (DHCS) published its Stakeholder Communication Update – December 2021.  Highlights include the following.  See update for details and additional information.  

• Continuous glucose monitors, as a pharmacy-billed medical supply benefit through Medi-Cal Rx, will be covered effective January 1, 2022.  See Medi-Cal Rx: Transitioning Medi-Cal Pharmacy Services from Managed Care to Fee-for-Service Frequently Asked Questions (Version 10.0 – December 3, 2021). 
• Medi-Cal Rx: For questions or comments related to Medi-Cal Rx, email RxCarveOut@dhcs.ca.gov 
• CMS has approved SPA 21-0028, adding MTM as a payable Medi-Cal Fee-for-Service pharmacy service provided in conjunction with certain complex chronic medical conditions. participate in the program, Medi-Cal-enrolled pharmacies will be required to enter a contract with DHCS.  

Also in California, the Department of Consumer Affairs issued a news release reminding providers of mandatory e-prescribing requirements effective January 1, 2022, pursuant to AB 2789 (Chapter 438, 2018). 

Finally in California, the Department of Justice (DOJ) recently announced that Bamboo Health will be the new vendor for prescription data collection services for the Controlled Substance Utilization Review and Evaluation System (CURES). Additional details and information will be provided in the coming weeks regarding the transition process in early 2022 from the current vendor, Atlantic Associates Inc. (AAI), to the new vendor, Bamboo Health.

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

The Medi-Cal Rx Web Portal has been updated with the following:  

• Medi-Cal Rx Web Claims Submission (WCS) User Guide. More information on User Administration Console (UAC) registration is available in the UAC Quick Start Guide. 
• Countdown to Go-Live — Are You Aware of the Cutoff Dates? includes important information and deadlines leading up to implementation of Medi-Cal Rx, effective January 1, 2022. 

Also in California, for Medi-Cal Rx updates, please visit the Department of Health Care Services’ Medi-Cal Rx: Transition website and the Medi-Cal Rx website. Medi-Cal Rx pharmacy stakeholders are strongly encouraged to sign-up for urgent announcements and other updates as they are posted to the Medi-Cal Rx website. Medi-Cal Rx will be effective January 1, 2022.  

Also in California, the Board of Pharmacy released the following Notices of Modified Text: 

• Further amending section 1715.6 to Title 16 of the California Code of Regulations related to Reporting Drug Losses.
  • Notice of Modified Text
  • Modified Text  

• Further amending section 1715.65 to Title 16 of the California Code of Regulations related to Inventory Reconciliation.
  • Notice of Modified Text
  • Modified Text  

Comments are due December 18 and can be submitted to Lori Martinez . 

Finally in California, This is a reminder that under SB 212 (2018), which established a prescription drug and sharps take-back program in California, retail pharmacies that sell a covered drug under their own label must submit written notification to the Board of Pharmacy identifying the covered entity from which the retail pharmacy obtains the covered product.  

“Covered entity” is defined under SB 212 as a manufacturer of covered products that are sold into the state. If there is not a manufacturer for a covered product, then the covered entity is the distributor of the covered product sold into the state. If there is not a manufacturer or distributor for a covered product, then the covered entity is the owner or licensee of a trademark or brand name under which covered products are sold into the state. If there is not a manufacturer, distributor, or owner or licensee of trademark or brand name, then the covered entity is the importer of the covered product into the state. 

Please click here to view the relevant provision in statute – Public Resources Code Section 42031(b).  

We have been made aware that few pharmacies required to report this information have not done so. If applicable, this is a reminder to please submit this information to the Board of Pharmacy’s Executive Officer, Anne Sodergren, at anne.sodergren@dca.ca.gov and lilly.fang@dca.ca.gov.  

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

The Medi-Cal Rx Monthly Bulletin for December has been posted. Below is an outline of this month’s updates. As a reminder, Medi-Cal Rx is schedule to be implemented effective January 1, 2021.

1. Changes to the Contract Drugs List (CDL), Effective December 1, 2021
2. Changes to the Contract Drugs List (CDL) – Over the Counter Drugs, Effective December 1, 2021
3. Changes to the Family PACT Pharmacy Formulary, Effective December 1, 2021
4. Medi-Cal Rx Medical Supplies Updates
5. Reimbursement for COVID-19 Vaccine Administration Claims
6. Updates to the Medi-Cal Rx Provider Manual
7. Adult Vaccination Administration Fee: Pharmacy Claims and Reimbursement
8. Maximum Allowable Ingredient Cost (MAIC) 30-Day Pharmacy Provider Notice
9. 45-Day Pharmacy Provider Notice
10. Contract Drugs List (CDL) Flyer
11. Medi-Cal Rx Provider Training Details
12. Registering Multiple NPIs in UAC
13. UAC Registration and Sign-In Troubleshooting
14. UAC Registration Reminders and Helpful Tips
15. Introducing the Medi-Cal Rx Education and Outreach Team
16. Prescriber Training Checklist
17. Pharmacy Training Checklist

Also in California, NACDS submitted comments to the Board of Pharmacy in support of the proposed rule revising 16 CCR §1746.4 pertaining to requirements for notification to patients’ primary care provider following vaccine administration. In modifying the notification provisions of the rule to apply only when requested by a patient, the proposed rule change would reduce the administrative burden of preparing and forwarding potentially redundant information that is not always needed or desired by every primary care provider, especially considering that pharmacies also report administered vaccines to the California Immunization Registry. Considering pharmacist and pharmacy workload demands having amplified during the COVID-19 pandemic, eliminating unnecessary administrative requirements free up pharmacy personnel to focus on meeting public demand for increased pharmacy services.

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

The following documents were recently posted on the Medi-Cal Rx Web Portal:   

• 45-day Pharmacy Provider Notice – Note: Magellan Medicaid Administration, Inc. encourages pharmacies to submit test transactions prior to the transition, effective January 1, 20221, and is offering a testing window October 11 through November 30. 
• User Administration Console (UAC) Registration and Sign-In Troubleshooting 

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

The following documents were recently posted on the Medi-Cal Rx Web Portal:  

• Introduction to Medi-Cal Rx Education & Outreach Team 
• User Administration Console (UAC) Registration – Alternate Address 
• Medi-Cal Rx Provider Training Details 

Also in California, Magellan informed NACDS and the California Retailers Association that many pharmacies have “requested” a PIN to register for the Medi-Cal Rx Provider Portal but less are activating their accounts.  As we get closer to the January 1, 2022, start date for Medi-Cal Rx, Magellan wants to make sure pharmacies are not only registered but have activated their accounts and are testing the provider portal.  

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

The Department of Health Care Services published its Medi-Cal Rx Monthly Bulletin – November 1, 2021 issue. Below is the outline from this month’s bulletin.  

1. Changes to the Contract Drugs List (CDL), Effective November 1, 2021 
2. Changes to the Contract Drugs List (CDL) – Over the Counter Drugs, Effective November 1, 2021 
3. Pharmacy Provider Notice 
4. Prior Authorization Fax Form Available 
5. Medi-Cal Rx Pharmacy Providers Electronic Fund Transfer Set Up and opt out 
6. Medi-Cal Rx Transition and Resources Training – Register Now! 
7. Medi-Cal Rx Transition Pharmacy Cutoff Instructions 

Also in California, as of January 1, 2022, all pharmacy benefits will transition away from CA-MMIS and the Medi-Cal managed care plans to Medi-Cal Rx. This transition will create a uniform process for pharmacy providers and prescribers and applies to everyone in Medi-Cal fee-for-service and managed care. All benefits that are billed on a pharmacy claim will be transitioned to Medi-Cal Rx and all Prior Authorizations (PA) will be reviewed by Medi-Cal Rx starting on January 1, 2022. Magellan Rx Management, the state’s vendor, created these resources and information to assist pharmacy providers in their preparations for the implementation of Medi-Cal Rx.  

• “Are you ready?” – Summary of information and resources for pharmacies and pharmacists. 
• The Contract Drugs List (CDL) is found on the Medi-Cal Rx Web Portal and contains the searchable Medi-Cal Formulary. The CDL displays drugs covered by Medi-Cal without a prior authorization (PA). The searchable CDL allows prescribers to easily identify all covered drugs. Registering for the Medi-Cal Rx Web Portal allows for easy access to the Provider Portal, where the CDL can be found through the Forms & Information link. 

Also in California, the following documents were recently posted on the Medi-Cal Rx Web Portal: 

• User Administration Console (UAC) Registration – Next Steps 
• User Administration Console (UAC) Quick Start Guide 
• User Administration Console (UAC) Registration Reminders and Helpful Tips 
• Pharmacist Training Checklist 

Also in California, the Department of Health Care Services (DHCS) is seeking eligible persons to expand the Medi-Cal Contract Drug Advisory Committee to a maximum of ten members, including three pharmacists. Interested persons may submit their statement of qualifications and CV/resume to DHCS by November 19. For details, see “Medi-Cal Contract Drug Advisory Committee (MCDAC)” on the DHCS website.  

Also in California, NACDS submitted comments to the Board of Pharmacy outlining concerns with proposed rules that would impose onerous inventory reconciliation requirements on pharmacies throughout the state. Our comments urged the Board not to layer on additional requirements beyond what DEA requires, explaining that the Board’s proposal would result in a cumbersome new process for pharmacies to accommodate.  

Also in California, the Board of Pharmacy published a Notice of Proposed Action that will require each permit holder to notify the board of any temporary closure of a facility as soon as the closure exceeds three consecutive calendar days. The closure status will be public information. Comments on the proposed text will be accepted by the board until December 13. 

Also in California, the Department of Consumer Affairs issued the following waiver extension:  

DCA Waiver DCA-21-200 Order Extending DCA-20-02, 20-57, 20-91, 21-165, and 21-187 Order Waiving License Reactivation or Restoration Requirements – Final Extension. A list of current waivers is available on the DCA website. 

Finally in California, the Department of Public Health developed a Q&A for booster doses now available for Pfizer, Moderna and Johnson & Johnson COVID-19 vaccines. 

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

The Board of Pharmacy issued a reminder that the following Pharmacy Law Waivers will expire on October 31:

• Duty to Consult (Title 16, California Code of Regulations, section 1707.2(a))
• Prelicensure Inspection at Proposed Location of an Automated Drug Delivery System (ADDS) – Business and Professions Code sections 4119.11(a)(9) and BPC 4427.2(e)

To request a site-specific waiver, use the guidelines posted at How to Request a Pharmacy Law Waiver under “COVID-19 Updates and Resources” on the Board’s website.

Also in California, last week, NACDS and the California Retailers Association sent a joint letter to Gov. Gavin Newsom (D) requesting that California authorize pharmacy technicians to administer flu vaccines to adults in accordance the eighth amendment to the federal declaration under the Public Readiness and Emergency Act (PREP Act). We also shared the letter with the Department of Consumer Affairs and the Board of Pharmacy.

Also in California, the Board of Pharmacy published a Notice of Proposed Action to amend sections 1793.5 and 1793.6 and to add 1793.65 to Title 16 of the California Code of Regulations related to Pharmacy Technicians. Written comments on the proposed text are due December 6.

Also in California, this week, Magellan released this webinar Q&A as an additional resource for pharmacy providers. Other resources from the Medi-Cal Rx webinar held on October 13 include both the presentation and the audio recording are available. To access the recording, use this link and click on “↓ Download (3 files)” in the upper right corner of the webpage. If your company would like to schedule its own training, please contact NACDS’ Sandra Guckian at 703-774-4801 or sguckian@nacds.org, and we will connect you directly to Magellan and the Department of Health Care Services to schedule the training.

Finally in California, the Department of Health Care Services issued a 60-day beneficiary letter to inform Medi-Cal members about Medi-Cal Rx, the transition of pharmacy services from Managed Medicaid to Fee-for-Service effective January 1, 2022.

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

The Board of Pharmacy posted the following:

• October 27 Communication and Public Education Committee meeting agenda and meeting materials and
• October 27-28 Full Board Meeting agenda and meeting materials.

Also in California, the Board of Pharmacy maintains an index of precedential decisions and makes it available annually to the public by email subscription.  Go to www.pharmacy.ca.gov to join the Board’s email list.

Also in California, NACDS and the California Retailers Association worked with Magellan and the Department of Health Care Services (DHCS) to conduct an informational webinar on October 13 for chain pharmacies to learn about the important elements related to implementation of Medi-Cal Rx (start date of January 1, 2022). Both the presentation and the audio recording are available.  To access the recording, use this link and click on “↓ Download (3 files)” in the upper right corner of the webpage. If your company would like to schedule its own training, please contact NACDS’ Sandra Guckian at 703-774-4801 or sguckian@nacds.org, and we will connect you directly to Magellan and DHCS to schedule the training.

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