Medi-Cal Rx: Transition
On January 7, 2019, Governor Gavin Newsom issued Executive Order N-01-19 (EO-N-01-19) for achieving cost-savings for drug purchases made by the state. A key component of EO N-01-19 requires the Department of Health Care Services (DHCS) transition all Medi-Cal pharmacy services from managed care (MC) to fee for service (FFS) by January 1, 2021.
Transitioning pharmacy services from MC to FFS will, among other things:
- Standardize the Medi-Cal pharmacy benefit statewide, under one delivery system.
- Improve access to pharmacy services with a pharmacy network that includes approximately 97 percent of the state’s pharmacies.
- Apply statewide utilization management protocols to all outpatient drugs.
- Strengthen California’s ability to negotiate state supplemental drug rebates with drug manufacturers.
The Medi-Cal pharmacy benefits and services administered by DHCS in the FFS delivery system will be identified collectively as “Medi-Cal Rx”.
As part of this transition, DHCS is committed to working with its external partners (including but not limited to, Managed Care Plans (MCPs), Counties, Providers, Consumer Advocates, and Beneficiaries) to ensure a smooth and successful transition through the following:
- Publicly releasing draft-informing materials (such as the Request for Proposal, provider and beneficiary notices, All Plan Letters, etc.) for comment.
- Ensuring MCPs, Counties, providers, consumer advocates, and beneficiaries receive timely and accurate information relating to the transition and associated implementation activities.
- Providing status updates and gathering stakeholder feedback through various DHCS-sponsored public meetings.
Note: In addition to stand-alone meetings, DHCS will be looking to leverage existing meetings and workgroups (e.g. stakeholder advisory committee, consumer stakeholder focus workgroup, Medi-Cal Medical Director’s meetings) to provide status updates on implementation efforts and activities related to Medi-Cal Rx.
The following are resources and reference materials for beneficiaries and providers regarding Medi-Cal RX services.
Below are presentations from DHCS-lead stakeholder engagement efforts related to Medi-Cal Rx. As DHCS hosts and/or participates in additional meetings that information will be added to this list as well.
Frequently Asked Questions
Below is a Medi-Cal Rx Frequently Asked Questions (FAQ) document that provides additional guidance and clarification to Medi-Cal beneficiaries, providers, plan partners, and other interested parties. As DHCS receives additional questions, this document will be updated as indicated by the version number and date in the footer.
For general questions relating to Medi-Cal Rx, please direct your comments and questions to RxCarveOut@dhcs.ca.gov.
For procurement-related questions, please direct your comments and questions to email@example.com. Since DHCS is embarking on an active procurement to secure an external pharmacy administrative services vendor for Medi-Cal Rx, DHCS cannot engage in any discussions or interactions with external parties regarding the procurement.