Implementation of the Medi-Cal Rx initiative begins on Jan. 1, and according to the Department of Health Care Services (DHCS), transitioning pharmacy services from Medi-Cal managed care to fee-for-service will greatly benefit both patients and providers. They said the transition would be a critical step for the success of the California Advancing and Innovating Medi-Cal (CalAIM) initiatives that start to roll out next month.
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The transition from Medi-Cal managed care to fee-for-service will standardize the Medi-Cal pharmacy benefit under one statewide delivery system, creating a single, statewide network that includes the majority of California’s pharmacies.
A DHCS spokesperson told State of Reform this means Californians on Medi-Cal can access their prescriptions regardless of what county they live in.
“This network of more than 6,300 pharmacies is broader than individual Medi-Cal MCP pharmacy networks … Centralizing pharmacy policy, transactions, and reimbursements will lead to greater efficiency for pharmacies, which, combined with a consistent application of a single set of utilization management policies across the state, will result in greater access for all beneficiaries of the Medi-Cal program.”
The spokesperson said Medi-Cal Rx will strengthen California’s ability to negotiate state supplemental drug rebates with drug manufacturers. They also said DHCS engaged prescribers and pharmacies through webinars, phone calls, newsletters, faxes, social media, YouTube, and flyers to develop the initiative.
“DHCS met regularly with both chain and independent pharmacies, as well as their associations, throughout the development of Medi-Cal Rx and anticipates pharmacies will benefit from having a single, standardized pharmacy benefit for the entire Medi-Cal population.”
DHCS also said although they expect challenges following implementation, the department and their contracted vendor, Magellan Medicaid Administration, Inc., would be ready to address any issues.