The original Medi-Cal Rx Transition Policy included “grandfathering” previously approved prior-authorizations and a 180-day period where DHCS would not require prior authorizations for existing prescriptions in order to provide a seamless beneficiary experience. Given systemwide issues in implementing the full pharmacy transition in January 2022, DHCS extended this transition policy until now.
In Phase III, Lift 1 (P3/L1), DHCS will lift the transition policy that overrode NCPDP Reject Code 75 – Prior Authorization Required for beneficiaries 22 and older. To see which standard therapeutic classes will be impacted by the first transition lift, click here.
Questions about the Medi-Cal Rx reinstatement? DHCS is hosting live webinars via Zoom every Friday at 12 p.m. No registration is required. This webinar will provide information specific to prior authorization requirements for beneficiaries 22 years of age and older, as well as discussion about the submission of prior authorizations in advance of the retirement of the Transition Policy. These Friday webinars will continue through the completion of reinstatement to provide relevant information in advance of each upcoming phase.