Assembly Bill 97 (AB 97) Ten Percent Pharmacy Payment Reductions and State Plan Amendment (SPA) 12-014
Assembly Bill 97 (Chapter 3, Statutes of 2011) requires the Department of Health Care Services (DHCS) to implement payment reductions up to ten percent to most categories of services in the Medi-Cal program, including pharmacy. DHCS received federal approval for the implementation of ten percent pharmacy payment reductions, effective June 1, 2011.
On January 30, 2014, DHCS received notification that the Centers for Medicare and Medicaid Services (CMS) approved SPA 12-014. This SPA approves DHCS' criteria and requirements for exempting specific drug products and/or categories of drugs, or specific pharmacy providers from the AB 97 related ten percent payment reductions and provides authority to implement the exemptions accordingly. The CMS approval letter for this SPA as well as information on all other DHCS SPAs is posted on the website.
This page provides information and updates for stakeholders on the implementation of the ten percent pharmacy payment reductions, the process for requesting exemption(s), as well as other updates to the 10% reduction and/or exemptions.
Stakeholder Updates (PDF):