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% 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.
For individuals with disabilities, the Department will provide assistive devices such as sign-language interpretation, real-time captioning, note takers, reading or writing assistance and conversion of training or meeting materials into Braille, large print, audiocassette, or computer disk. To request such services or copies in an alternate format, please call or write:
Department of Health Care Services
Pharmacy Benefits Division, MS 4604
Sacramento, CA 95814
Phone Number: (916) 552-9500
Please note, the range of assistive services available may be limited if requests are received less than ten working days prior to the meeting or event.
Medi-Cal Rx Advisory Workgroup
The Medi-Cal Rx Advisory Workgroup will meet seven (7) times in-person between January 2020 and April 2021 to help facilitate and further inform DHCS' ongoing Medi-Cal Rx implementation efforts. Each Medi-Cal Rx Advisory Workgroup meeting will be held in Sacramento for approximately four hours. The Medi-Cal Rx Advisory Workgroup membership will be limited to 30 members to ensure a productive discussion environment. The Medi-Cal Rx Advisory Workgroup to be comprised of organizations and entities such as hospitals, clinics, health plans, counties, pharmacies, tribal health programs, consumer advocates and others. During the meetings, DHCS will provide updates on the pharmacy transition and request the Medi-Cal Rx Advisory Workgroup provide dialogue and input key topics, such as:
Roles and responsibilities of DHCS, the Medi-Cal Rx Contractor, and Medi-Cal Managed Care Plans
DHCS' implementation strategies, tools, and timelines, including but not limited to, provider education and outreach and beneficiary notifications
Medi-Cal pharmacy policy development, which will include the scope of the carve out, prior authorization, and utilization management protocols
Changes to existing Medi-Cal pharmacy committees
Post-transition, the Medi-Cal Rx Advisory Workgroup meetings will focus on gathering information, experiences and/or feedback from workgroup members to help refine Medi-Cal Rx processes and policies on an ongoing basis. The meetings will be open to the public, and in-person public comment will be accepted for the last 30 minutes of each meeting. Additional details, including but not limited to check-in and parking information, will be posted with the agenda and meeting materials at least 10 days prior to each meeting.
Medi-Cal Rx Advisory Workgroup Meeting schedule
Meeting #1: January 14, 2020 (Tuesday)
Meeting #2: March 18, 2020 (Wednesday)
Meeting #3: May 26, 2020 (Tuesday) *Updated*
Meeting #4: July 29, 2020 (Wednesday)
Meeting #5: October 21, 2020 (Wednesday)
Meeting #6: February 8, 2021 (Monday)
Meeting #7: April 12, 2021 (Monday)
Medi-Cal Rx Public Forum
During calendar year 2020, DHCS will host three (3) larger Medi-Cal Rx Public Forums in-person and via webinar, which will be one (1) hour in length and provide status updates to help ensure that the broader stakeholder community is kept up-to-date about Medi-Cal Rx implementation activities and timelines. DHCS will only take questions and comments from those participants attending in-person. All interested organizations and entities, including but not limited to, hospitals, clinics, health plans, counties, pharmacies, tribal health programs, and consumer advocates, are invited to participate.
Medi-Cal Rx Public Forum Schedule
Meeting #1: February 18, 2020 (Tuesday)
- Meeting #2 : June 17, 2020 (Wednesday)
Meeting #3: December 9, 2020 (Wednesday)
DHCS will release additional information as well as reminder notices through various DHCS stakeholder email distribution lists. In addition, DHCS will also post a final agenda and meeting materials at least 10 days prior to each meeting.
Resources and Reference Materials
The following are resources and reference materials for beneficiaries and providers regarding Medi-Cal RX services:
For general questions relating to Medi-Cal Rx, please direct your comments and questions to RxCarveOut@dhcs.ca.gov.