Medi-Cal Rx：将 Medi-Cal 药房服务从管理式医疗转变为按服务收费的常见问题​​ 

版本 16.0​​ 

八月31 ， 2023​​ 

The following Frequently Asked Questions (FAQs) document provides additional guidance and clarification to Medi-Cal beneficiaries, providers, plan partners, and other interested parties regarding the transition of Medi-Cal’s pharmacy benefit (collectively referred to as “Medi-Cal Rx”). As the Department of Health Care Services (DHCS) receives additional questions, this document will be updated as indicated by the version number and date on the title page.​​  

For information regarding Medi-Cal Rx, please visit DHCS’ dedicated Medi-Cal Rx Transition website. In addition, general questions regarding Medi-Cal Rx may also be submitted to DHCS via email at medi-cal.pharmacybenefits@dhcs.ca.gov.​​ 

目录​​ 

一般信息​​ 
采购信息​​ 
过渡信息​​ 
数据馈送、电子访问和其他临床支持​​ 
供应商拓展、教育和培训​​ 
受益人客户服务及相关支持​​ 
受益人资格、费用分摊及其他健康保险相关问题​​ 
Medi-Cal 按服务收费报销方法​​ 
政策考量​​ 
事先授权/使用管理​​ 
340B 联邦药品折扣计划​​ 
Medi-Cal Rx 投诉/申诉解决和上诉流程​​ 
财政影响/评估​​ 
杂项/其他信息​​ 

一般信息​​ 

1. 为什么卫生保健服务部 (DHCS) 要将 Medi-Cal 药房福利从 Medi-Cal 管理式医疗服务体系转变为按服务收费服务体系？​​ 

DHCS transitioned Medi-Cal pharmacy services from the Medi-Cal managed care delivery system to the Medi-Cal fee-for-service delivery system as a result of Governor Gavin Newsom’s January 7, 2019 Executive Order N-01-19, for the purpose of achieving cost-savings for drug purchases made by the state, to standardize the pharmacy benefit statewide for all Medi-Cal members, and to increase overall access by allowing members to receive pharmacy services from the broader fee-for-service pharmacy network. In addition, this standardization is a critical step for the success of the California Advancing and Innovating Medi-Cal (CalAIM) initiatives being proposed by DHCS. For more information on CalAIM, visit the DHCS’ website.​​ 

2.什么是 Medi-Cal Rx？​​ 

Medi-Cal Rx 是美国卫生保健服务部 (DHCS) 对集体药房福利和服务起的名称，这些福利和服务自全面运营 (AOO) 起由 Magellan Medicaid Administration, LLC (MMA) 通过按服务收费交付系统进行管理。​​  

3. 完整的 Medi-Cal Rx 运营假设 (AOO) 代表什么？​​ 

Medi-Cal Rx AOO 代表 Magellan Medicaid Administration, LLC (MMA) 承担支持 Medi-Cal Rx 所需的所有剩余管理服务运营责任的日期，包括但不限于索赔管理、事先授权 (PA) 和利用管理 (UM)、提供商和会员支持服务以及其他辅助和报告服务。 Medi-Cal Rx 完整 AOO（如问题 #23-25中所述）于 1 月1日、 2022日进行。 欲了解更多详细信息，请参阅问题 28-30 。​​ 

4. 将 Medi-Cal 药房福利从管理式医疗转变为按服务收费有哪些优势？​​ 

将药房服务从 Medi-Cal 管理式医疗转变为按服务收费将带来以下好处：​​ 

• 在统一的配送系统下，实现全州范围内 Medi-Cal 药房福利的标准化。​​ 
• Improve access to pharmacy services with a pharmacy network that includes the vast majority of the state’s pharmacies and is generally more expansive than individual Medi-Cal Managed Care Plan (MCP) pharmacy networks.​​ 
• 根据需要，将全州范围的使用管理 (UM) 协议应用于所有门诊药物。​​ 
• Strengthen California’s ability to negotiate state supplemental drug rebates with drug manufacturers as the largest Medicaid program with more than 15 million members.​​ 

5. DHCS 是否需要寻求联邦政府的批准才能实施 Medi-Cal Rx？​​ 

是的。DHCS 已向联邦医疗保险和医疗补助服务中心 (CMS) 申请批准，通过CalAIM 第 1915(b) 条豁免申请将药房福利从管理式医疗服务体系转变为按服务收费。 豁免申请反映了药房在药房索赔中收取的药房福利的豁免，包括承保的门诊药品和医生管理的药品，如Medi-Cal Rx 全计划函( APL20-020 ) 中所述，自 1 月1 、 2022起生效。​​ 

6. 哪些 Medi-Cal 管理式医疗计划 (MCP) 会受到 Medi-Cal Rx 的影响，哪些不会？​​ 

所有 Medi-Cal MCP（包括艾滋病医疗基金会）都受到影响。 Medi-Cal Rx 不适用于老年人全包护理计划 (PACE)、老年护理行动网络 (SCAN) 或重大风险医疗保险计划 (MRMIP)。​​ 

7. Will Medi-Cal Rx apply to California Children’s Services (CCS) and the Genetically Handicapped Persons Program (GHPP)? If yes, will Medi-Cal Rx change CCS, and how does it intend to address CCS-unique issues?​​ 

Medi-Cal Rx 适用于 CCS 和 GHPP。 自 Medi-Cal Rx 全面投入运营 (AOO) 以来，所有事先授权 (PA) 请求（正式名称分别为服务授权请求或治疗授权请求） - 无论是针对独立县还是从属县，以及仅限 CCS、仅限 GHPP 和 CCS/GHPP Medi-Cal 成员 - 均通过 Medi-Cal Rx 处理药房索赔中开具的药房福利。​​ 

正如下面问题 24所述，DHCS 负责所有药物覆盖和政策责任，并制定与 PA 裁决相关的所有标准。 此外，认识到 CCS/GHPP 人群的特殊医疗保健需求，DHCS 继续与 CCS 咨询小组及该领域的其他主要利益相关者密切合作。​​ 

8. Medi-Cal Rx 中哪些部分不会改变？​​ 

Medi-Cal Rx 不会改变以下内容：​​ 

• The scope of the existing Medi-Cal pharmacy benefit.​​ 
• 在住院或长期护理 (LTC) 环境中（包括专业护理机构 [SNF] 和其他中级护理机构 [ICF]），将药房服务作为捆绑/全包计费结构的一部分提供，无论采用何种交付系统。​​ 
• 现有的 Medi-Cal 管理式医疗药房豁免（例如，血液因子、HIV/AIDS 药物、抗精神病药物或用于治疗物质使用障碍的药物）。​​ 
• 任何以医疗和/或机构索赔而非药房索赔形式计费的药房服务。​​ 
• 州公平听证会 (SFH) 流程，如适用加利福尼亚州法律所定义。​​ 

9. Medi-Cal Rx 如何影响住院或长期护理 (LTC) 环境中提供的药品的付款？​​ 

如问题 8 所述，如果某种药物是作为 LTC/专业护理机构 (SNF) 提供的服务捆绑费率的一部分提供的，那么它仍将由 Medi-Cal 管理式医疗计划 (MCP) 负责。 否则，如果处方药不属于 LTC/SNF 提供的服务捆绑费率的一部分，而是按服务收费，则这些药品的财务责任由其计费的索赔类型决定。 如果药品由药房分发并在药房索赔单上开具账单，那么这些药品将由 Medi-Cal Rx 扣除并支付。 如果药品由 LTC/SNF 提供并根据医疗/机构索赔开具账单，则 MCP 负责，如果会员是按服务收费的，则由加州医疗补助管理信息系统 (CA-MMIS) 财政中介负责。​​ 

10. What pharmacy benefits will be “carved out” of Medi-Cal managed care due to Medi-Cal Rx?​​ 

Medi-Cal Rx 已接替 Medi-Cal 管理式医疗计划 (MCP) 的职责，负责在药房根据药房索赔开具账单时管理以下事项：​​ 

• 承保门诊药品，包括某些医生开具的药品 (PAD)​​ 
• 特定医疗用品​​ 
• 肠内营养产品​​ 

服务中包含的未计入 MCP 人头费的药品（例如血液因子、HIV/AIDS 药物、抗精神病药物或用于治疗物质使用障碍的药物）无论索赔类型如何（即药房或医疗索赔）均不计入人头费（排除在外）。 这些类别药物的医疗索赔应继续作为按服务收费索赔提交给 Medi-Cal 财政中介机构 (FI)。 需要提醒医疗服务提供者的是，未列在药房合同药品清单 (CDL) 中且由
非药房医疗保健专业人员管理的药品通常应由管理提供者作为医疗索赔收取，而不是由药房收取。​​ 

非按人头收费药品豁免类别名单中新增的药品通常需要至少 60 天的时间才能成功开具账单。 要求提供商保留他们的索赔，直到系统准备好接受它们为止。​​  

For more information, please see DHCS’ Medi-Cal Scope document located on the DHCS’ website. This document provides additional context and information related to DHCS’ implementation of the Medi-Cal managed care to fee-for-service pharmacy carve-out. It also provides an inventory of the Medi-Cal pharmacy benefit, characterized as either not subject to the carve-out (that is, those pharmacy benefits that are billed on medical and institutional claims) or subject to the carve-out (that is, all pharmacy benefits that are billed on pharmacy claims).​​ 

11. Medi-Cal Rx 全面投入运营 (AOO) 后，DHCS 将如何处理糖尿病用品（包括试纸、采血针、血糖仪、控制溶液和采血针）的承保？​​ 

糖尿病试纸（用于检测尿液、血糖和酮体）和采血针的福利政策在 Medi-Cal Rx 下没有改变，并且受 Medi-Cal 提供商手册的医疗用品部分当前公布的合同产品清单和标准的约束。​​  

此信息可在Medi-Cal Rx 提供商手册和Medi-Cal Rx 门户网站上找到。​​ 

自 1 年 1 月 、 2022 1 月 21 日生效，特定血糖仪、质控液和采血装置均属于通过 Medi-Cal Rx 获得的药房计费医疗供应福利，并且仅限于新创建的涵盖的自我监测血糖系统（血糖仪）、质控液和采血装置清单（可在 Medi-Cal Rx 门户网站上获取）中的产品，以便作为药房福利考虑纳入 Medi-Cal R 承保范围。此类别中未包含在该列表中的适用产品将被视为不符合 Medi-Cal Rx 作为药房福利的承保资格。​​ 

未列入承保自我监测血糖系统（血糖仪）、对照溶液和采血设备清单的非合同产品，可以通过 Medi-Cal 管理式医疗计划 (MCP) 或按服务收费的财政中介 (FI) 作为医疗索赔中 HCPCS 计费的耐用医疗设备 (DME) 福利进行报销。 数量限制保持不变。​​ 

12. DHCS 目前如何处理一次性外部便携式胰岛素输送系统（Omnipod 和 V-Go）的覆盖范围？自 Medi-Cal Rx 全面投入运营（AOO）以来，这种情况是否发生了变化？​​ 

Disposable Insulin Delivery Devices (DIDDs) are pharmacy-billed medical supply benefits through Medi-Cal Rx, effective January 1, 2022,and are restricted to the products on the List of Covered Disposable Insulin Delivery Devices on the Medi-Cal Rx Web Portal. These products are identified as “Partial” carve outs on the Medi‑Cal Rx Scope document; therefore, all DIDD claims billed on a pharmacy claim must be submitted to  Medi-Cal Rx, and HCPCS-billed medical claims must be submitted to either Medi-Cal Managed Care Plans (MCPs) or the fee-for-service Fiscal Intermediary (FI). NDC-billed claims submitted after the transition to Medi-Cal Rx for products not found on this list will be denied.​​ 

DIDD 需要事先授权 (PA) 才能报销，并且适用特定的承保标准。 DIDD 包含在过渡政策中。 对于先前作为CMS-1500表格上计费的医疗福利支付的索赔，提供商在提交所请求产品的药房索赔时，应包括先前随医疗福利索赔一起提交的有效 PA 和继续治疗的书面说明，以确保满足承保要求。​​ 

13. 在 Medi-Cal Rx 全面投入运营 (AOO) 后，DHCS 如何处理连续血糖监测仪 (CGM)、其他耐用医疗设备 (DME)、DME 用品和一次性医疗用品的覆盖范围？​​ 

Therapeutic CGM Systems became a pharmacy-billed medical supply benefit through Medi-Cal Rx, effective January 1, 2022. These products are identified as “Partial” carve outs on the Medi-Cal Rx Scope document. Therefore, a CGM pharmacy claim must be submitted to Medi-Cal Rx. CGM Systems are included under the Medi-Cal Rx Transition Policy. For claims previously paid as a medical benefit billed on a CMS-1500 form, documentation of the most recently paid medical claim, and written justification for continuation of therapy, should be included for the requested product to ensure that coverage requirements are met.​​ 

 Coverage is restricted to products on the List of Covered Therapeutic Continuous Glucose Monitoring (CGM) Systems and requires a Prior Authorization (PA) for reimbursement. Specific coverage criteria continue to apply. Refer to the List of Covered Therapeutic Continuous Glucose Monitoring (CGM) Systems and the Medi-Cal Rx Provider Manual on the Medi-Cal Rx Web Portal for specific information.​​ 

对于按服务收费 (FFS) 的 Medi-Cal 受益人，从 10 月1日、 2022开始，之前通过 HCPCS 代码在 CMS 1500 表格上作为医疗福利支付的索赔必须作为药房索赔提交给 Medi-Cal Rx。 这些 HCPCS 代码将拒绝 12 月1 、 2022之后提交的服务日期的医疗索赔。​​ 

注意：一些 CGM 设备对应的胰岛素泵将继续作为 DME 收费，作为医疗福利通过 HCPCS 代码在 CMS 1500 表格上计费。 请参阅 Medi -Cal 提供商网站上的 Medi- Cal 药房提供商手册的 DME 部分，了解有关 DME 胰岛素泵和配件的承保范围和账单信息。​​ 

Medi-Cal Managed Care members should contact their individual Medi-Cal Managed Care Plan (MCP) as MCPs may determine their own CGM coverage policy, criteria, and reimbursement. CGM is a partially carved-out medical supply; therefore, MCPs can determine if they will continue to provide the benefit themselves or through Medi-Cal Rx. Managed care CGM coverage policies are available on the individual MCP’s website for provider and member clarification.​​ 

14. 在 Medi-Cal Rx 全面投入运营 (AOO) 后，DHCS 将如何处理当前或以前按 HCPCS 代码和 CMS-1500 表格作为医疗索赔开具账单的其他医疗用品福利？​​ 

Unless otherwise noted on the Medi-Cal Rx Scope Document, all other Durable Medical Equipment (DME) and DME supplies continue, unchanged, and reimbursable as an HCPCS-billed DME benefit through the fee-for-service Fiscal Intermediary (FI), on a medical claim.​​ 

Sterile Syringes with Needles (non-insulin), a disposable medical supplies item currently billed via HCPCS code on a CMS-1500 form, will become a pharmacy-billed medical supply benefit through Medi-Cal Rx, effective January 1, 2022, restricted to products on the newly created List of Covered Sterile Syringes with Needles (non-insulin), which can be found on the Medi-Cal Rx Web Portal. NDC‑billed claims submitted after transitioning to Medi-Cal Rx for products not found on this list will be denied. These products are identified as “Partial” on the Medi‑Cal Rx Scope document; therefore, claims billed on a pharmacy claim must be submitted to Medi-Cal Rx, and claims billed as HCPCS-billed medical claims must be submitted to either Medi-Cal Managed Care Plans (MCPs) or the fee-for-service Fiscal Intermediary. Restrictions will remain unchanged: 200 syringes every 30 days without prior authorization.​​ 

Alcohol Prep Pads, a disposable medical supplies item, are a pharmacy-billed medical supply benefit through Medi-Cal Rx. These products are identified as “Partial” on the Medi-Cal Rx Scope document; therefore, claims billed on a pharmacy claim must be submitted to Medi-Cal Rx, and claims billed as HCPCS-billed medical claims must be submitted to either Medi-Cal MCPs or the fee-for-service FI. Alcohol swab sticks are not included in this category and are not a Medi-Cal Rx benefit. Alcohol swab sticks will continue to be reimbursable as an HCPCS-billed medical supplies benefit through the
fee-for-service FI.​​ 

15. Medi-Cal Rx 是否包括医疗和/或机构索赔中开具的药房福利？​​ 

No, since the Medi-Cal Rx full Assumption of Operations (AOO), Medi-Cal pharmacy services billed on a medical or institutional claim by a pharmacy, or any other provider, continue to be billed through either Medi-Cal Managed Care Plans (MCPs) or to the California Medicaid Management Information System (CA-MMIS) Fiscal Intermediary, for either Medi-Cal MCP members or fee-for-service members, as they were prior to the Medi-Cal Rx full AOO. However, drugs that are “carved out” of the managed care delivery system (for example, blood factor, HIV/AIDS drugs, antipsychotics, or drugs used to treat substance use disorder) will be billed to CA-MMIS for both fee-for-service and MCP members.​​ 

16. Are COVID-19 vaccines “carved out” of Managed Care Plans (MCPs)?​​ 

Consistent with the approach being taken by Medicare through Medicare Advantage Plans, the Department of Health Care Services (DHCS) carves out the COVID-19 vaccine from Medi-Cal MCPs and reimburses providers under the fee-for-service delivery system for both medical and pharmacy claims. This approach eases program administration, eliminates challenges with
out-of-network provider reimbursements, and keeps vaccine administration fee rates consistent for providers regardless of delivery system.​​  

17. Medi-Cal 将如何向医疗服务提供者报销 COVID-19 疫苗接种费用？​​ 

Medi-Cal reimburses the associated COVID-19 vaccine administration fee at the allowable Medicare rate for all claims (medical, outpatient, and pharmacy) based on the number of required doses. As the federal government pays for the initial vaccines, there is no Medi-Cal provider reimbursement for the COVID-19 vaccine itself. However, the cost of the vaccine will be reimbursed once COVID-19 vaccines become commercialized in Fall 2023. For more information about the COVID-19 vaccine, visit https://covid19.ca.gov/ and the Department of Health Care Services’ (DHCS) COVID-19 Response web page.​​  

18. Where can I find DHCS’ guidance and coverage/reimbursement policy relative to the COVID-19 vaccine?​​ 

Refer to the COVID-19 Vaccines, OTC Antigen Test Kits, and Therapeutics: Coverage and Reimbursements section of the Medi-Cal Rx Provider Manual for DHCS’ policy and reimbursement guidance on COVID-19 vaccines.​​ 

For additional information about COVID-19, visit https://covid19.ca.gov/ and DHCS’ COVID-19 Response web page.​​  

19. Are COVID-19 Over The Counter Self-Administered Antigen Tests “carved out” of Managed Care Plans (MCPs)?​​ 

The Department of Health Care Services’ (DHCS) coverage of COVID-19 OTC Self-Administered Antigen Tests as a pharmacy-billed benefit through Medi-Cal Rx was effective February 1, 2022, in accordance with current Centers for Disease Control and Prevention (CDC) recommendations. Quantity limitations and specific product coverage criteria apply. For additional information, visit the Medi-Cal Rx Provider Portal via the Medi-Cal Rx Web Portal and refer to the Covered Emergency Use of Authorization (EUA) COVID-19 Antigen Tests list on the Forms & Information page, or refer to the Over‑the‑Counter (OTC)COVID-19 Antigen Test Kits section of the Medi-Cal Rx Provider Manual.​​ 

采购信息​​ 

20. 卫生保健服务部如何管理 Medi-Cal Rx？​​ 

DHCS 于 2019 年 8 月 22 日发布了提案请求 (RFP) #19-96125，以采购行政服务承包商来管理 Medi-Cal 收费药房服务，当时服务对象超过 1350 万 Medi-Cal 会员。 2019 年 12 月 13 日，DHCS 授予 Magellan Medicaid Administration, LLC (MMA) 一份合同，以根据 DHCS 的指示提供一套全面的管理服务，包括但不限于索赔管理、事先授权 (PA) 和利用管理 (UM)、药房药品回扣管理、提供商和会员支持服务，以及其他辅助和报告服务，以支持 Medi-Cal 药房福利的管理。​​ 

21. Medi-Cal Rx 采购时间表是什么？​​ 

Medi-Cal Rx 采购相关工作的时间表如下：​​  

• 2019 年 7 月 22 日：Medi-Cal Rx 提案请求 (RFP) 草案 #19-96125 发布，进行为期两周的公众意见征询期。​​ 
• 2019 年 8 月 22 日：最终 Medi-Cal Rx RFP #19-96125 发布。​​ 
• 2019 年 8 月 29 日：最终 Medi-Cal Rx RFP #19-96125 问题提交给卫生保健服务部 (DHCS)。​​ 
• 2019 年 9 月 17 日：发布了与最终 Medi-Cal Rx RFP #19-96125 和附录相关问题的答案。​​ 
• 2019 年 10 月 1 日：所有 Medi-Cal Rx RFP #19-96125 提案均需提交。​​ 
• 2019 年 11 月 7 日：授予意向通知发布至 DHCS 网站。​​ 
• 2019 年 12 月 13 日：DHCS 将合同授予 Magellan Medicaid Administration, LLC (MMA)。​​ 
• 2019 年 12 月 20 日：合同生效日期。​​ 
• January 1, 2022: Medi-Cal Rx Full Assumption of Operations (AOO) took place.​​ 

22. 通过采购流程选定的 Medi-Cal Rx 承包商是谁？​​ 

被选定管理 Medi-Cal 收费药房服务的 Medi-Cal Rx 承包商是 Magellan Medicaid Administration, LLC (MMA)。​​ 

23. What roles and responsibilities will Medi-Cal Managed Care Plans (MCPs) maintaining upon Medi-Cal Rx’s full Assumption of Operations (AOO)?​​ 

Medi-Cal MCP 将负责包括但不限于以下活动：​​ 

• 监督和维护已登记的 Medi-Cal 会员护理协调和相关活动所需的所有活动，与合同义务一致。​​ 
• 对药房依从性的所有临床方面提供监督和管理，包括提供疾病和药物管理。​​ 
• 处理和支付医疗和机构索赔所需的所有药房服务费用。​​ 
• 参加与 Medi-Cal 全球药物使用审查 (DUR) 委员会和其他由卫生保健服务部 (DHCS) 主导的药房委员会会议相关的会议。​​ 
• 持续参与索赔后裁决 DUR 活动，例如回顾性 DUR（RetroDUR）（护理协调所必需）、教育计划以及提交 DUR 年度报告。​​ 

24. What roles and responsibilities will DHCS maintain upon Medi-Cal Rx’s full Assumption of Operations?​​ 

DHCS 将负责包括但不限于以下活动：​​ 

• 制定、实施和维护所有 Medi-Cal 药房政策，包括但不限于：​​ 
  • 药物覆盖​​ 
  • 州补充药品回扣​​ 
  • 事先授权 (PA)/利用管理 (UM)​​ 
• 就国家补充药品回扣进行谈判和签订合同。​​ 
• Reviewing and issuing final determinations regarding all PA denials for Medi-Cal Rx benefits, including those for California Children’s Services (CCS) program/Genetically Handicapped Persons Program (GHPP).​​ 
• 监督并协助州公平听证会 (SFH) 流程。​​ 
• 建立 Medi-Cal Rx 药房报销方法，符合适用的州和联邦要求。​​ 
• 建立和维护 Medi-Cal 药房提供商网络。​​ 
• 与 Magellan Medicaid Administration, LLC (MMA) 合作，监督 Medi-Cal 全球药物使用审查 (DUR) 委员会和其他部门驱动的药房委员会。​​ 
• 合同管理和 MMA 的监督/监控。​​ 

25. What roles and responsibilities will the Medi-Cal Rx Contractor assume upon Medi-Cal Rx’s full Assumption of Operations?​​ 

Magellan Medicaid Administration, LLC（MMA）将负责包括但不限于以下活动：​​  

• 提供每天 24 小时、每周 7 天、每年 365 天提供服务的 Medi-Cal Rx 客户服务中心 (CSC)（除经批准的节假日外，或除非卫生保健服务部 (DHCS) 另有指示），以支持所有提供商和会员呼叫，并提供外展、培训和通知材料。​​ 
• 提供直接的 Medi-Cal 管理医疗计划 (MCP) 联络，以协助护理协调和临床问题。​​ 
• Providing real-time access into MMA’s electronic environment via a secure portal to all Medi-Cal providers (prescribers and pharmacies) and MCPs, Mental Health Plans, and Substance Use Disorder Plans.​​ 
• 为药房索赔中计费的所有药房服务提供索赔管理、处理和支付功能。​​ 
• 监督福利（COB）与其他健康保险（包括医疗保险）的协调。​​ 
• Providing utilization management (UM) functionalities, including ensuring pharmacy prior authorization (PA) adjudication occurs within 24 hours, inclusive of California Children’s Services (CCS) program/Genetically Handicapped Persons Program (GHPP).
  Note: All pharmacy PA denials will require DHCS’ review prior to final determination.​​ 
• 提供前瞻性和回顾性药物使用审查 (DUR) 服务。​​ 
• 向 Medi-Cal MCP 提供数据反馈（至少每天一次），以支持其会员护理协调、执行药房依从性的临床方面以及疾病和药物管理的职责。​​ 
• Providing drug rebate administration services that are compliant with federal and state laws and adhere to DHCS’ policies and direction.​​ 

Between January 1, 2021, and Medi-Cal Rx’s full Assumption of Operations (AOO) on January 1, 2022, DHCS – in partnership with MMA – provided various Medi-Cal Rx Transitional Supports and services (TSS), as outlined in greater detail below in questions #30 and #31.​​ 

26. 卫生保健服务部如何确保 Medi-Cal Rx 承包商不会将患者数据（包括处方信息）用于 Medi-Cal Rx 管理服务以外的任何目的？​​ 

The requirements for appropriate use of Medi-Cal member information are outlined, clearly and in detail, in Medi-Cal Rx Request for Proposal (RFP) #19-96125, which becomes part of the final executed contract language. In addition, Magellan Medicaid Administration, LLC (MMA) is required to adhere to all existing state and federal requirements as well as DHCS’ policies relating to sensitive data and privacy.​​ 

27. 在哪里可以找到有关 Medi-Cal Rx 提案请求#19-96125 的更多信息？​​ 

有关 Medi-Cal Rx 提案请求#19-96125 的更多信息，请访问FI$Cal/Cal eProcure 网站。 最终提案截止日期为 10 月1日2019下午 4 点（太平洋夏令时）。 采购流程现已结束。​​ 

过渡信息​​ 

28. Medi-Cal Rx 何时全面投入运营（AOO）？​​ 

Medi-Cal Rx full AOO, as described in questions #23-25, inclusive of claims administration and prior authorization adjudication functionalities, will took place January 1, 2022.​​  

29. Why was the planned Go-Live date of April 1, 2021 for Medi-Cal Rx’s full Assumption of Operations delayed?​​ 

The Department of Health Care Services (DHCS) delayed the planned Go-Live date of April 1, 2021, for Medi-Cal Rx because of the need to review new conflict avoidance protocols submitted by Magellan Medicaid Administration, LLC (MMA), the project’s contracted vendor.​​ 

2021年1月，Centene Corporation宣布计划收购Magellan。 Centene 通过子公司运营管理式医疗计划 (MCP) 和参与 Medi-Cal 的药房。 这笔交易是出乎意料的，需要更多时间来探索可接受的冲突避免协议，以确保公司实体之间存在可接受的防火墙，以保护所有 Medi-Cal 成员的药房索赔数据，并保护其他专有信息。​​ 

Medi-Cal Rx remains of utmost importance to the State of California as a tool to standardize the Medi-Cal pharmacy benefit statewide under one delivery system. Medi-Cal Rx applies statewide utilization management (UM) protocols to all outpatient drugs, standardizing the experience for all Medi-Cal members and providers. Medi-Cal Rx also strengthens California’s ability to negotiate state supplemental drug rebates with drug manufacturers, helping to reduce pharmaceutical costs.​​ 

30. Did Medi-Cal Rx use a “phased” approach to transition services?​​ 

No, full implementation of Medi-Cal Rx took place on January 1, 2022. However, between January 1, 2021, and Medi-Cal Rx full Assumption of Operations (AOO), the Department of Health Care Services (DHCS), in partnership with Magellan Medicaid Administration, LLC (MMA), provided various Medi-Cal Rx Transitional Supports and Services (TSS), including but not limited to:​​ 

• 允许 Medi-Cal 提供商、管理式医疗计划 (MCP) 和其他相关方注册 Medi-Cal Rx 安全门户并参加全面培训，以确保更全面地了解项目并支持提供商和 MCP 的运营准备。​​ 
• 站起来并动员 Medi-Cal Rx 客户服务中心 (CSC)，让 CSC 的专家处理和回答来自 Medi-Cal 会员、提供商、MCP 和其他相关方的问题，从而有可能在 Medi-Cal Rx 全面实施后避免出现混乱和其他潜在挑战。 尽管 CSC 专家在 AOO 之前没有提供全套服务，但他们在
  Medi-Cal Rx 完整 AOO 之后提供了全套服务。 他们能够提供重要的 TSS，包括主动联系供应商，以及与 Medi-Cal Rx 工具和功能相关的有针对性的援助和关键信息。​​ 
• 为 MCP 提供了额外的时间与专门的 Medi-Cal Rx 临床联络员进行互动并建立融洽关系，这些联络员帮助 MMA 建立准确、全面的 MCP 档案，以确保继续满足每个 MCP 服务人群的个性化需求。​​ 
• Allowed DHCS and MMA to roll out additional Medi-Cal Rx website and secure portal functionalities and tools in advance of Medi-Cal Rx full AOO, including, but not limited to, the Medi-Cal Rx Pharmacy Locator tool,
  Medi-Cal Rx Provider Manual, Medi-Cal Rx Contract Drugs List (CDL), and other related policy and programmatic information.​​ 

在 Medi-Cal Rx 全面 AOO 之后，MMA 承担了支持 Medi-Cal Rx 所需的所有剩余管理服务的责任，包括但不限于以下内容：​​ 

• 将 CSC 的服务时间延长至每天 24 小时、每周 7 天、每年 365 天（经批准的节假日除外，或除非 DHCS 另有指示），以支持所有提供商和会员呼叫，以及外展、培训和通知材料。​​ 
• 索赔管理、事先授权 (PA) 和利用管理 (UM)、提供商和会员支持服务以及其他辅助和报告服务。​​  

欲了解更多详细信息，请参阅问题 23-25 。​​ 

31. DHCS 如何确保在过渡过程中利用 Medi-Cal 管理式医疗计划 (MCP) 和其他利益相关者的知识和经验来实现服务的成功连续性？​​ 

DHCS 已积极通过多种方式和多种渠道与外部合作伙伴合作，以确保利用知识和经验使 Medi-Cal Rx 取得成功。 DHCS 打算继续开展此类参与工作，并致力于与其外部合作伙伴（包括 Medi-Cal MCP、县、供应商、消费者权益保护者和受益人）合作，以确保顺利和成功地过渡。 例如，DHCS 建立了专门的 Medi-Cal MCP 工作组和 Medi-Cal Rx 咨询工作组，由各利益相关者代表组成，定期开会讨论各种问题，确定最佳做法，并提供可行的解决方案和策略来支持 DHCS 的实施工作。​​ 

展望未来，DHCS 还将继续积极探索机会，简化和加强围绕 Medi-Cal 的现有利益相关者的参与和外展工作，其中将包括有针对性的 Medi-Cal Rx 工作组会议和讨论，以合作制定满足所有受影响方需求的最佳实践和实施策略。​​ 

32. 如何传达有关 Medi-Cal Rx 转换和其他相关变化的信息？​​ 

DHCS 将与 MMA 合作，确保所有相关方（包括但不限于 Medi-Cal MCP、精神健康计划、物质使用障碍计划、提供者和受益人）了解过渡和其他相关变化。​​ 

沟通将通过多种方式传播，包括但不限于以下方式：​​ 

• 新的Medi-Cal Rx 门户网站于 2020 年 6 月上线，作为向相关方宣传和传达可用资源、信息和变化的平台。 教育内容和常见问题会经常发布和更新。​​ 
• 从 2020 年 6 月开始， Medi-Cal Rx 订阅服务 (MCRxSS)可通过 Medi-Cal Rx 门户网站获得，感兴趣的各方可以注册并通过电子邮件定期接收 Medi-Cal Rx 更新。​​ 
• 自 2020 年 8 月起，感兴趣的各方可以在 Medi-Cal Rx 门户网站上看到有关变更的公告。​​ 
• 新的 Medi-Cal Rx 网站提供一系列针对 Medi-Cal 提供商和 MCP 的培训和教育材料。 自 2020 年 9 月起，MCP 和提供商就可以报名参加培训和教育活动。​​ 
• 我们已于 10 月1 、 2020 、11 月1日、 2020和 12 月15日、 2020日左右向 MCP 和按服务收费提供系统中的 Medi-Cal 受益人邮寄了通知。 从 2021 年 3 月底开始，我们还向 Medi-Cal 受益人邮寄通知，告知他们 Medi-Cal Rx 全面投入运营 (AOO) 将延迟。 向 Medi-Cal 受益人发送的附加通知已于2021年 11 月1左右邮寄，宣布将于2022年 1 月1日进行 AOO。​​ 
• Medi-Cal MCP Medi-Cal Rx 外展活动，通过传统外拨电话活动或 DHCS 批准的其他替代通信方式向已登记的会员开展。​​ 
• 更新 Medi-Cal 管理式医疗计划会员手册（承保范围证明），以及其他受影响实体的通知材料。​​ 
• 按照 DHCS 的指示，对Medi-Cal 提供商手册进行更新，以及 MMA 发布的新的提供商指南和材料。​​ 
• 根据需要更新 Medi-Cal MCP 合同，以反映药房福利从管理式医疗到按服务收费的转变。​​ 
• 为 MCP 创建新的 Medi-Cal Rx 全计划信函，并为县级服务提供商和其他主要合作伙伴提供其他相关信息通知。​​ 
• 创建与 Medi-Cal Rx 相关的新的管理医疗保健全计划信函部门，为 Medi-Cal MCP 提供从监管、合规和归档角度的指导。​​ 
• Medi-Cal MCP 费率更新。​​ 
• Regular updates via existing stakeholder processes and workgroups, including but not limited to DHCS’ bimonthly Stakeholder Communication Update, Medi‑Cal Rx Public Forum, Medi-Cal Global Drug Use Review Board, Medi-Cal Pharmacy Directors’ Meeting, Stakeholder Advisory Committee, California Children’s Services Advisory Committee, etc.​​ 

33. DHCS 将如何确保过渡到 Medi-Cal Rx 的 Medi-Cal 受益人不会遭遇护理中断和/或无法获取必要的处方药？​​ 

To assist Medi-Cal beneficiaries, providers (prescribers and pharmacies), and Managed Care Plans (MCPs) with the Medi-Cal Rx full Assumption of Operations (AOO), DHCS will provide various Medi-Cal Rx Transitional Supports and Services (TSS) between January 1, 2021, through Medi-Cal Rx full AOO on January 1, 2022, as described in more detail in question #30 above and has developed and will implement a multi-faceted pharmacy transition policy. The pharmacy transition policy will use strategies such as “grandfathering” previously approved prior authorization (PA) requests through their stated duration, not to exceed one (1) full year from the date the prescription was written, unless the drug is included in the list of exceptions allowing for extended/multi-year PAs up to five (5) years for certain drug classes/categories. The transition period also includes a 180-day period where DHCS will not require PA for existing prescriptions without previously approved PAs from their applicable Medi-Cal MCPs, for drugs not on the Medi-Cal Contract Drugs List (CDL), or that otherwise have PA requirements under Medi-Cal Rx. This policy does not apply to new prescriptions or drugs that do not have PA requirements under Medi-Cal Rx. During this transition period, Magellan will provide system messaging, reporting and outreach to provide for a smooth transition to Medi-Cal Rx. This pharmacy transition period will facilitate a smooth, productive transition, ensuring that Medi-Cal beneficiaries do not experience disruption in their access to medically necessary prescriptions while maintaining compliance with all state and federal laws related to the Medi-Cal pharmacy benefit. DHCS’ Pharmacy Transition Policy is available on the Medi-Cal Rx Transition webpage.​​ 

34. DHCS 是否会制定 Medi-Cal Rx 过渡计划？如果会，该计划将包括哪些部分？​​ 

是的，根据提案请求#19-96125、附件 A、附件 I - 工作范围 - 接管中概述的要求，Magellan Medicaid Administration, LLC (MMA) 和 DHCS 将制定 Medi‑Cal Rx 药房过渡方法/计划，其中至少包括以下流程：​​ 

• 为 Medi-Cal 药房和处方人员提供足够的通知和灵活性，以采取一切必要步骤适应新的 Medi-Cal Rx 承包商、 Medi-Cal 合同药品清单 (CDL)和相关流程。​​ 
• 向 Medi-Cal 受益人提供 DHCS 和 Medi-Cal 管理式医疗计划 (MCP) 就过渡事宜提供的适当通知和相关材料。​​ 
• 通过允许正在进行的（在 Medi-Cal Rx 全面投入运营 [AOO] 之前开始的药物治疗）药物在没有首先获得批准的 PA 的情况下进行分发和计费，为在过渡期内分发的药物获得事先授权 (PA) 提供指导。 不过，药品安全的未来药物使用审查 (DUR) 要求仍然适用。​​ 
• 药房、提供者和受益人援助，包括确保受影响方收到有关 Medi-Cal Rx 药房过渡期和相关流程的适当通知和其他信息。​​ 

35. DHCS 将在 Medi-Cal Rx 过渡计划中使用哪些策略来确保受益人顺利有效地过渡到 Medi-Cal Rx？​​ 

To assist Medi-Cal beneficiaries with the full Medi-Cal Rx transition, DHCS will provide various Medi-Cal Rx Transitional Supports and Services (TSS) between January 1, 2021, through Medi-Cal Rx full Assumption of Operations (AOO) on January 1, 2022, as described in more detail in question #30 above. In addition, DHCS’ pharmacy transition policy, as described in question #33 above, and in more detail in the link below, will use strategies such as the following:​​ 

• “Grandfathering” previously approved prior authorizations (PAs) through their stated duration, not to exceed one (1) full year from the date the prescription was written, unless the drug is included in the list of exceptions allowing for extended/multi-year PAs up to five (5) years for certain drug classes/categories, as articulated in the policy.​​ 

For more information, please review DHCS’ Pharmacy Transition Policy on the Medi-Cal Transition webpage.​​ 

36. Medi-Cal 管理式医疗计划 (MCP) 是否应停止和/或取消在 Medi-Cal Rx 全面投入运营 (AOO) 时或之前由 Medi-Cal MCP 裁定和批准的任何先前授权 (PA)？​​ 

不，Medi-Cal MCP 不应中止和/或取消此类 PA，同样也不应让授权在 Medi-Cal Rx 全面 AOO 前一天自动失效。 DHCS 和 Medi-Cal MCP 都应采取必要措施，确保 Medi‑Cal 受益人在过渡到 Medi-Cal Rx 期间能够继续获得医疗必需的药房福利和服务。​​ 

数据馈送、电子访问和其他临床支持​​ 

37. Medi-Cal Rx 是否会为 Medi-Cal 提供商、Medi-Cal 管理式医疗计划 (MCP) 和其他实体提供药房数据和必要的电子访问权限，以支持护理协调？​​ 

是的，Medi-Cal Rx 将向 Medi-Cal MCP 提供数据馈送（至少每天一次），以支持他们履行受益人护理协调、执行药房依从性的临床方面以及疾病和药物管理的职责。 DHCS 继续探索与精神健康和物质使用障碍计划数据馈送相关的选项和建议，并将与该领域的主要利益相关者进行接触。 任何商定的解决方案都将在 Medi-Cal Rx 全面投入运营后实施。​​ 

此外，Medi-Cal Rx 将通过安全门户为所有 Medi-Cal 提供商（开处方者和药房）、Medi-Cal MCP、精神健康和物质使用障碍计划以及 DHCS 指定的其他实体提供对 MMA 电子环境的适当实时访问。​​ 

38. Medi-Cal Rx 将为 Medi-Cal 管理式医疗计划 (MCP) 提供哪些额外的临床和护理协调支持？​​ 

MMA 将为 Medi-Cal MCP 提供额外的临床和护理协调支持，以履行其与 Medi-Cal 受益人护理协调、药物依从性和其他相关责任有关的合同义务，方式如下：​​ 

• Providing a dedicated Medi-Cal MCP clinical liaison team to interface with the Medi-Cal MCPs, other MMA staff, and MMA’s portal/environment to assist with and resolve clinical pharmacy-related issues for Medi-Cal Rx, including those involving prior authorization, as directed by DHCS.​​ 
• 保持足够的专职 Medi-Cal MCP 临床联络员的人员配备比例，以确保为 Medi-Cal MCP 维持这种级别的访问。​​ 
• Providing access to the Medi-Cal MCP clinical liaisons through Medi-Cal Rx’s dedicated Integrated Voice Response system to assist and resolve clinical pharmacy-related issues.​​ 

For more information, please see the Medi-Cal Rx MCP Clinical Liaison Policy and the Medi-Cal Rx Website and Pharmacy Portal Policy.​​ 

供应商拓展、教育和培训​​ 

39. DHCS 为 Medi-Cal Rx 提供和/或计划提供哪些类型的提供商外展、教育和培训以及相关支持？​​ 

DHCS 与 MMA 合作，致力于提供 Medi-Cal 提供商客户支持服务，包括但不限于以下内容：​​ 

• 客户服务中心 (CSC) 支持所有提供商呼叫，每天二十四 (24) 小时、每周七 (7) 天、每年三百六十五 (365) 天（经批准的节假日除外，或 DHCS 另有指示的除外）。​​ 
• 向 Medi-Cal 提供商、Medi-Cal 管理式医疗计划 (MCP) 和其他实体提供外展、培训和信息材料。​​ 
• 基于网络的服务，支持 Medi-Cal Rx 的通信和工具。​​ 
• Real-time access into MMA’s electronic environment via a secure portal.​​ 
• 其他服务和支持，以确保顺利有效的过渡（例如，Medi-Cal Rx 过渡支持和服务 (TSS) 和 180 天药房过渡期）。​​ 

此外，MMA 的 Medi-Cal Rx CSC 代表将代表 DHCS 在各种场所向提供商（开处方者和药房）、药房计费代理和计划合作伙伴传达和提供有关 Medi-Cal Rx 信息和培训材料的主题专业知识/支持。 欲了解更多信息，请参阅提案请求#19-96125 附件 A，附件 II – 工作范围 – 运营 – 教育和推广。​​ 

Additional information about provider outreach, education, and training, including schedules and sign-up information, is and will be made available on DHCS’ dedicated Medi-Cal Rx Web Portal. In addition, providers and all other interested parties are encouraged to sign up for the Medi-Cal Rx Subscription Service (MCRxSS) to receive news and updates related to Medi-Cal Rx.​​ 

会员客户服务及相关支持​​ 

39. DHCS 为 Medi-Cal Rx 提供和/或计划提供哪些类型的 Medi-Cal 受益人客户服务和相关支持？​​ 

DHCS 与 Magellan Medicaid Administration, LLC (MMA) 合作，致力于为会员提供客户服务和相关支持，包括但不限于以下内容：​​ 

• Medi-Cal Rx 客户服务中心 (CSC) 为所有会员提供全天候服务，每周 7 天、每天 24 小时，每年 365 天（经批准的节假日除外，或 DHCS 另有指示的除外）。​​ 
• 通过不同的途径告知与 Medi-Cal Rx 相关的材料，包括但不限于通过美国邮政和基于网络的服务发送适当的通知（例如，面向外部的网站以支持 Medi-Cal Rx 的沟通和工具）。​​ 
• The Medi-Cal Rx Pharmacy Locator (PLT) tool is available on the
  Medi-Cal Rx Web Portal and includes all Medi-Cal Rx eligible pharmacies.​​ 
• 交互式语音应答 (IVR) 系统提供：​​ 
  • 记录信息​​ 
  • 自助服务选项​​ 
  • 能够请求客户服务后续跟进，例如回电电话或通过邮件或电子邮件提供信息。​​ 

In addition, MMA’s Customer Service Representatives (CSRs) act on behalf of DHCS to relay and provide subject-matter expertise/support regarding
Medi-Cal Rx information and related materials to Medi-Cal members, in a variety of venues. For more information, see Request for Proposal (RFP)
#19-96125 Exhibit A, Attachment II – Scope of Work – Operations – Education and Outreach.​​ 

会员资格、费用分摊及其他健康保险相关问题​​ 

40. Relative to the transition to Medi-Cal Rx, what happens to the claims if a beneficiary’s eligibility is in “on-hold” status and is waiting for the county to adjust the beneficiary’s eligibility?​​ 

The “on-hold” status pertains to the beneficiary’s Medi-Cal Managed Care Plan eligibility status and there is no change to this process under Medi-Cal Rx. Medi‑Cal Rx will be evaluating the Health Care Plan (HCP) status in the Medi-Cal Eligibility Data System (MEDS) to determine an active versus inactive status and proceed accordingly.​​ 

41. Relative to Medi-Cal Rx, what happens if the beneficiary has moved and the county has not updated the beneficiary’s eligibility?​​ 

There is no change to Medi-Cal’s overarching eligibility processes as a result of the transition to Medi-Cal Rx. Medi-Cal Rx will be evaluating the Health Care Plan (HCP) status in the Medi-Cal Eligibility Data System (MEDS) to determine an active versus inactive status and proceed accordingly.​​ 

42. Are there any changes to Medi-Cal’s Share of Cost (SOC) policy where self-pay and spend-down have to occur before the Medi-Cal benefits?​​ 

Medi-Cal’s overarching SOC policy is not changing, and associated processes and policies would remain unchanged under Medi-Cal Rx.​​ 

43. 当 Medi-Cal 受益人拥有其他健康保险（OHC）时，哪种健康保险和福利套餐被视为主要健康保险和福利套餐？​​ 

Medi-Cal’s overarching OHC policy is not changing and, in most instances, Medi‑Cal is the payer of last resort.​​ 

44. Medi-Cal Rx 会影响同时拥有 Medi-Cal 和 Medicare（D 部分）保险的 Medi-Cal 受益人吗？​​ 

不会。Medi-Cal Rx 不会影响或以其他方式改变同时拥有 Medi-Cal 和 Medicare（D 部分）保险的 Medi‑Cal 受益人的任何药物保险。 Medi-Cal 可能涵盖 Medicare（D 部分）可能不涵盖的处方药福利，因此 Medi-Cal 受益人也应与他们的提供商讨论。​​ 

Medi-Cal 按服务收费报销方法​​ 

45. 对于 Medi-Cal 药房，Medi-Cal 按服务收费药房报销方法是如何建立的，其组成部分有哪些？​​ 

DHCS utilizes drug reimbursement methodologies as defined in state law and the Medi-Cal State Plan. Medi-Cal fee-for-service pharmacy reimbursement is the lower of the drug’s ingredient cost plus a professional dispensing fee or pharmacy’s usual and customary charge to the public.​​ 

1. 卫生保健服务部 (DHCS) 将药物成分成本计算为以下两项中的最低者：​​ 
   • 该药品的全国平均药品采购成本 (NADAC)，或当没有 NADAC 时，批发采购成本 (WAC) + 0%，或​​ 
   • 联邦上限（FUL），或​​ 
   • 最高允许成分成本（MAIC）。​​ 
2. 专业配药费用（根据医疗补助和非医疗补助年度药房索赔总额[即配发处方]分为两级）：​​ 
   • 每年 90,000 起索赔：10.05 美元​​ 

For 340B claims, reimbursement is covered entity’s actual drug acquisition cost plus the appropriate professional dispensing fee.​​ 

For more information on the Departments MAIC program, view the Maximum Allowable Ingredient Cost (MAIC) Program Frequently Asked Questions.​​ 

46. Does the Department of Health Care Services (DHCS) reimburse specialty pharmacies for medication management services provided to patients identified as “high-risk” for compliance, adherence, or medication misuse concerns?​​ 

DHCS has established the Medication Therapy Management (MTM) program as authorized in Welfare and Institutions Code (W&I Code) Section 14132.969 as part of pharmacist services to support, ensure continued access, and reimburse specialty pharmacies for the services which they offer. Part of this is establishing and maintaining a list of covered specialty drug categories, eligibility criteria, and conditions for which MTM pharmacist services will be reimbursed. DHCS contracts with any willing Medi-Cal enrolled pharmacy providers, as authorized in W&I Code, Section 14105.3, to provide MTM pharmacist services to Medi-Cal members for covered specialty drug categories and to patients that meet the eligibility criteria in the contracts. For additional details, see DHCS’ web page Update on Medication Therapy Management Pharmacy Services.[NI1]​​  

 [NI1]The last question # 48 in V15 has been deleted in this version​​ 

政策考量​​ 

47. What is Medi-Cal’s Contract Drugs List (CDL)?​​ 

The Department of Health Care Services (DHCS) maintains the CDL, which is DHCS’ list of covered drugs and includes drugs for which there is a current state supplemental drug rebate agreement in place. Generally, under the existing Medi-Cal fee-for-service pharmacy benefit, if a drug is listed on the CDL, then it does not require an approved prior authorization (PA) for coverage. Alternatively, if a drug is not listed on the CDL, then it would require an approved PA for coverage. Note that even if a drug is listed on the CDL, it may still require an approved PA for coverage; however, if a certain drug on the CDL requires an approved PA, then DHCS’ policy would clearly articulate that requirement.​​ 

View the CDLs on the Contract Drugs List page on the Medi-Cal Rx Web Portal.​​ 

48. How will Medi-Cal Rx affect Medi-Cal’s Contract Drugs List (CDL), and does DHCS take anything else into consideration for its Medi-Cal drug coverage policies?​​ 

Medi-Cal RxCDL replaced the previous DHCS-approved Medi-Cal CDL as the list of covered drugs. In addition, DHCS’ pharmacy drug coverage policies take into consideration:​​ 

• 所有经美国食品药品管理局 (FDA) 批准的承保门诊药品（由医疗保险和医疗补助服务中心 (CMS) 定义），均须符合医疗必要性。​​ 
• DHCS’ business rules that detail requirements for the covered outpatient drugs and non-drug products, and limitations of coverage, which include aid code, program, and/or date-specific coverage.​​ 
• 
  View the CDLs on the Contract Drugs List page on the Medi-Cal Rx Web Portal.
  ​​ 

49. Will Medi-Cal Rx consider local exceptions to Medi-Cal’s Contract Drugs List (CDL)?​​ 

No. Medi-Cal Rx uses a single, statewide, and Department of Health Care Services (DHCS)-approved CDL to standardize the Medi-Cal pharmacy benefit. View the CDLs on the Contract Drugs List page on the Medi-Cal Rx Web Portal.​​ 

50. DHCS 如何决定在合同药品清单 (CDL) 中添加或删除药品？​​ 

DHCS 可以根据收到的以下信息将药品添加到 Medi-Cal CDL 中：(1) 来自制造商、医生和/或药剂师的外部个人药品申请 (IDP) 请求，或 (2) DHCS 发起的 IDP 审查（如果适用）。 收到 IDP 后，DHCS 将对请求进行广泛审查，同时考虑循证文献、行业最佳实践以及以下药物审查标准，这些标准在《福利和机构法典》第 14105.39(c)(1) 节中有概述 以及（2）：​​ 

• 药物的安全性​​ 
• 药物的有效性​​ 
• 药物的基本需求​​ 
• 药物滥用的可能性​​ 
• 药物对计划的成本​​ 

In addition to conducting its own internal review, DHCS also consults with the Medi-Cal Drug Advisory Committee (Committee), as required by Welfare and Institutions Code Section 14105.4. The Committee is composed of members who are appointed by DHCS’ Director – including community physicians and pharmacists, faculty members from academic pharmacy institutions, and Medi-Cal beneficiaries – and assists DHCS by providing written recommendations to inform decision-making regarding adding and/or deleting, drug(s) from the Medi-Cal CDL. The Committee’s final response with detailed, drug-by-drug recommendations is due within 30 calendar days of DHCS requesting consultation, and takes into consideration the Welfare and Institutions Code Section 14105.39(c)(1) and (2) criteria, as well as additional information such as generic name, brand name, federal Food and Drug Administration (FDA)-approved indications, manufacturer, fiscal/cost impact, clinical criteria, etc.​​ 

DHCS then makes an informed and documented decision whether or not to add the drug to the Medi-Cal CDL based upon the Committee’s recommendations, state law requirements, and other relevant factors.​​ 

As DHCS moves closer to Medi-Cal Rx’s full Assumption of Operations on January 1, 2022, it is continuing its efforts to closely analyze variances and gaps between Medi-Cal Managed Care Plan (MCP) formularies and the Medi-Cal CDL. As a product of DHCS’ analysis, and in an effort to drive down the total number of required prior authorizations, numerous medications have been added to the Medi-Cal CDL since January 2020, and DHCS will continue this review on a monthly basis to add more medications to the Medi-Cal CDL.​​ 

51. 与 Medi-Cal Rx 相关的法定变更有哪些？​​ 

Yes, DHCS’ proposed Trailer Bill language was part of the Governor’s Fiscal Year 2020-21 budget, which made the following changes:​​ 

• Repealed the six-prescription (“6 Rx”) drug limit.​​ 
• 取消了 Medi-Cal 按服务收费的处方共付费用。​​ 
• Redefined “Best Price” for Medi-Cal drugs to allow for drug prices outside the United States to be considered for state supplemental drug rebate contracts.​​ 

52. 对于需要事先授权 (PA) 的药品，开处方者或提供者每次配药时是否都需要提交 PA？​​ 

不是，PA 可以涵盖批准的 PA 期限内分配的多个填充。​​ 

53. DHCS 是否已做出政策改变以允许多年的事先授权 (PA) 批准？​​ 

To reduce administrative burden while ensuring continuation of care and medication safety for members, DHCS has enabled extended duration/multi-year PAs for up to five years for certain maintenance medications used for chronic conditions. Qualified prescriptions are automatically extended. See the Extended Duration Prior Authorizations for Maintenance Medications alert for additional information.​​ 

54. 卫生保健服务部（DHCS）是否会考虑改变政策以增强和/或扩大自动裁决功能？​​ 

作为 Medi-Cal Rx 的一部分，DHCS 不断增强和/或扩展自动裁决功能（例如，自动索赔批准和支付），以减少需要人工审查的具有事先授权 (PA) 要求的药品数量。​​ 

55. Medi-Cal Rx 是否包括阿片类药物管理服务？​​ 

Medi-Cal Rx provides opioid management services in accordance with House Resolution 6 Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act,​​ 

Medi-Cal pharmacy policy and procedures, and clinically appropriate, evidence-based guidelines. To promote transparency and increased awareness, the Department of Health Care Services (DHCS) has shared this information externally at various stakeholder events, including but not limited to the Medi-Cal Rx Managed Care Plan (MCP) workgroup and
Medi-Cal Rx Advisory workgroup. For more information regarding DHCS’ current pharmacy policies and procedures in this space, see the reference resource.​​ 

此外，作为 Medi-Cal Rx 的一部分，DHCS 在提案请求 (RFP) 中征求了提案，以进一步探索超出联邦法律要求的增强型阿片类药物管理利用管理工具。 展望未来，DHCS 将考虑实施拟议的增强型阿片类药物管理服务。​​  

56. Medi-Cal Rx 是否包括药房锁定计划？​​ 

The Department of Health Care Services (DHCS) did not implement a lock-in program as part of the Medi-Cal Rx full Assumption of Operations (AOO) on January 1, 2022, but will evaluate options with Magellan Medicaid Administration, LLC (MMA) in the future. As part of the Medi-Cal Rx Request for Proposal (RFP) #19-96125, DHCS solicited proposals to explore further pharmacy lock-in program options, including, but not limited to, things such as: use of multiple pharmacies, different prescribers of controlled substances, and number of controlled substances. In addition, DHCS is aware that approximately 50 percent of Medi-Cal Managed Care Plans (MCPs) utilize pharmacy lock-in programs today, so through stakeholder engagement efforts, DHCS will be looking to learn more and utilize best practices for
Medi-Cal Rx.​​ 

57. 在哪里可以找到从政策和计划角度提供指导的针对 Medi-Cal 管理式医疗计划 (MCP) 的 Medi-Cal Rx 全计划信函？​​ 

DHCS’ new Medi-Cal All Plan Letter APL 20-020 for Medi-Cal MCPs can be found on DHCS’ website.​​ 

58. 在哪里可以找到与 Medi-Cal Rx 相关的针对 Medi-Cal 管理式医疗计划 (MCP) 的管理式医疗保健部全计划函，该函从监管、合规和备案角度提供指导？​​ 

The DMHC All Plan Letter APL 20-035 relative to Medi-Cal Rx is available on the Department of Managed Health Care’s website.​​ 

59. Where can I find the Informational Notice (IN) for the California Children’s Services (CCS) program and the Genetically Handicapped Persons Program (GHPP) relative to Medi-Cal Rx?​​ 

The IN 20-03 for CCS and GHPP programs relative to Medi-Cal Rx is available on DHCS’ website.​​ 

60. 在哪里可以找到提供与县心理健康和物质使用障碍 (SUD) 服务的 Medi-Cal Rx 相关指导的行为健康信息通知 (BHIN)？​​ 

The BHIN that provides guidance related to Medi-Cal Rx for county mental health and Substance Use Disorder services is currently under development and, once finalized, we will be available on the Behavioral Health Information Notices page on DHCS’ website.​​  

事先授权/使用管理​​ 

61. 根据 Medi-Cal Rx，如何审查和裁决事先授权 (PA) 请求？​​ 

DHCS shall, in collaboration with MMA, process PA requests and provide a response to the submitting provider within 24 hours of receiving a PA request, pursuant to Welfare and Institutions Code Section 14133.37. A more detailed process document is posted on DHCS’ Medi-Cal Rx Transition website. ​​ 

62. Medi-Cal 管理式医疗计划 (MCP) 是否可以与 Medi-Cal Rx 承包商签订合同来执行事先授权 (PA)？​​ 

否。由于 Medi-Cal Rx 于1年2022月全面投入运营后，Medi-Cal MCP 将不再对 Medi-Cal 药房福利承担合同责任，因此所有 PA 裁定和相关流程都将由 MMA 处理，符合合同要求并按照 DHCS 的指示。​​ 

340B 联邦药品折扣计划​​ 

63. 什么是联邦 340B 计划？​​ 

《公共卫生服务法》第 340B 条（美国法典第 42 篇第 256b 条）建立了一项称为 340B 药品定价计划（340B 计划）的联邦计划，该计划是在 1992 年采用医疗补助药品回扣计划后制定的。 卫生资源与服务管理局是美国卫生与公众服务部下属的一个机构，通过其药房事务办公室负责管理该计划。​​ 

The 340B Program requires drug manufacturers to offer drugs to certain hospitals and other healthcare providers (covered entities) at a greatly reduced price. By selling drugs at lower prices, participating drug manufacturers are not required to pay Medicaid drug rebates on drugs purchased through the 340B Program and provided to a Medicaid beneficiary (better known as the provision against “duplicate discounts”).​​ 

64. 谁使用 340B 计划？​​ 

Section 340B (a) (4) of the Public Health Services Act (Title 42 United States Code Section 256b) specifies which covered entities are eligible to participate in the 340B Program. These include qualifying hospitals, federal grantees from the Health Resources and Services Administration (HRSA), the Centers for Disease Control and Prevention (CDC), the Department of Health and Human Services’ Office of Population Affairs, and the Indian Health Service. Eligible covered entities are defined in statute and include HRSA-supported health centers and lookalikes, Ryan White clinics and State AIDS Drug Assistance programs, Medicare/Medicaid Disproportionate Share Hospitals (DSH), children’s hospitals, and other safety net providers.​​ 

When registering as a covered entity with HRSA, a covered entity may choose not to dispense 340B purchased drugs to Medicaid members or to dispense 340B purchased drugs to Medicaid members. HRSA maintains a file of covered entities that indicates whether the entity dispenses 340B purchased drugs to Medicaid patients. Although covered entities can purchase 340B drugs for all eligible patients, state Medicaid programs may only collect rebates on drugs purchased outside of the 340B Program. Additional details are available on HRSA’s 340B Drug Pricing Program website.​​ 

65. 我们的处方药提案和340B计划之间有什么相互作用？​​ 

Drugs purchased under 340B pricing and dispensed to Medicaid enrollees are excluded from both federal and state rebate collection. This exclusion prevents drug manufacturers from providing duplicate discounts on drugs purchased through the 340B Program.​​ 

2009 年 10 月，加利福尼亚州将一项现有政策编入法典，要求 340B 覆盖实体仅向 Medi-Cal 成员分发 340B 库存，并在通过 Medi-Cal 按服务收费交付系统分发时按其实际采购成本 (AAC) 收取这些药品的费用，这与福利和机构法典 (W&I 法典) 第 14105.46 节一致。 340B 实际采购成本计费要求仅适用于按服务收费的交付系统。​​ 

在管理式医疗服务体系中，分发给 Medi-Cal 会员的 340B 药品不受 Medi-Cal 按服务收费采购成本计费要求的约束。 这样，覆盖实体和 Medi-Cal 管理式医疗计划 (MCP) 和/或签约药房福利管理人员 (PBM) 可以协商报销安排，从而使管理式医疗服务体系中的 340B 覆盖实体获得比在 Medi-Cal 按服务收费服务体系中获得的报销更高的报销金额。 这些利润不与国家分享，国家也不知道这些利润的数额。​​ 

Medi-Cal Rx 可以实现政策统一，并加强对通过 340B 计划分发和计费的药物索赔的监督。​​ 

66. Medi-Cal Rx 是否阻止提供商继续作为 340B 实体？​​ 

不会。此外，该提案不会改变或取消加州的 340B 计划。​​ 

67. 卫生保健服务部 (DHCS) 如何解决有关 Medi-Cal Rx 对 340B 计划管理的影响的担忧？​​ 

DHCS 认识到我们的安全网提供商的重要作用以及他们为 Medi-Cal 受益人所做的关键工作。 DHCS 已经并将继续合作，代表医疗机构和团体与各相关方和利益相关者进行讨论，以更好地了解 Medi-Cal Rx 的实施对其 340B 计划和相关流程的影响，并进一步讨论缓解影响的潜在方案。​​ 

68. DHCS 将如何分配和/或为非医院 340B 诊所提供补充支付池？​​ 

DHCS 召集了一个利益相关者工作组来制定向符合条件的非医院 340B 社区诊所分配补充资金的方法。 工作组讨论的主题包括获得补充支付的资格标准、各个财政年度可用的资金池总额，以及在符合条件的非医院 340B 社区诊所之间分配资金池的标准，包括由此产生的补充支付的时间、频率和金额。 国家计划修正案（SPA）已获得批准。 此外，根据第2023号议会法案的规定，DHCS 将对 2017 年28月 日到2023 31 1 2023符合条件的非医院 340B 社区诊所就诊费用进行补贴。​​ 

Medi-Cal Rx 投诉/申诉解决和上诉流程​​ 

69. Medi-Cal 受益人将采取哪些投诉和申诉解决流程来解决药房福利问题？​​ 

In partnership with MMA, DHCS is committed to implementing and overseeing an effective Medi-Cal Rx complaint and grievances process to ensure appropriate triaging, referral, and/or disposition. Specific requirements are outlined in Request for Proposal #19-96125, Exhibit A, Attachment II – Scope of Work Operations – Complaints and Grievances Resolution. In addition, DHCS’ Medi-Cal Rx Complaints and Grievances Policy is posted on DHCS’ Med-Cal Rx Transition webpage.​​ 

70. 哪些与药房相关的投诉和申诉将通过 Medi-Cal Rx 处理？​​ 

All pharmacy-related complaints and grievances for Medi-Cal Rx services provided after the Medi-Cal Rx full Assumption of Operations on January 1, 2022, will be handled through Medi‑Cal Rx’s Customer Service Center for triaging, research, and resolution. For more information, please see DHCS’ Medi-Cal Rx Complaints and Grievances Policy.​​ 

71. 在 Medi-Cal Rx 全面投入运营 (AOO) 时或之前，卫生保健服务部 (DHCS) 如何处理针对 Medi-Cal 管理式医疗计划 (MCP) 提供的药房相关服务而产生的投诉和不满？​​ 

Pharmacy-related complaints and grievances for services rendered or requested on or before Medi-Cal Rx full AOO on January 1, 2022, by a Medi-Cal MCP, which are for services the MCP was at risk for, must be fully adjudicated by the Medi-Cal MCP in accordance with DHCS’ All Plan Letter 17-006 and any subsequent versions.​​ 

在 Medi-Cal Rx 全面 AOO 之后，Medi-Cal Rx 客户服务中心 (CSC) 收到的针对 Medi-Cal MCP 在 Medi-Cal Rx 全面 AOO 之前或之前提供的服务的药房相关投诉和申诉将由 Medi‑Cal Rx CSC 转交给相应的 Medi-Cal MCP 以进行全面解决。​​ 

Medi-Cal Rx CSC 将建议 Medi-Cal MCP 会员就此类与药房相关的投诉和不满联系他们的 MCP。​​ 

Medi-Cal MCP 会员有权向其 Medi-Cal MCP 提交关于在 Medi-Cal Rx 全面 AOO 时或之前提供的药房相关服务的投诉和申诉，而这一权利不受 Medi-Cal Rx 的影响。​​ 

72. Does Medi-Cal Rx have a mechanism to share information about complaints and grievances with the beneficiary’s Managed Care Plan (MCP)?​​ 

Medi-Cal MCPs will have complete access to individual records of beneficiaries enrolled in their plan via the Medi-Cal Rx Web Portal, including documentation of complaints and grievances. This information can be reviewed by the plan case manager on a case-by-case basis as needed. Further, relative to complaints and grievances external reporting, DHCS is exploring options and will leverage existing modalities relative to sharing this information publicly through various avenues such as DHCS’ website and Open Data Portal.​​ 

73. Medi-Cal 受益人将采用哪些上诉机制来解决药房福利问题？​​ 

Appeals go through the State Fair Hearing process, which is administered through the California Department of Social Services. If Medi-Cal beneficiaries do not agree with a denial or change of Medi-Cal Rx services, they can ask for a State Fair Hearing. Fair Hearings can be requested online or by phone, fax, mail, or email. For more information about the State Hearing process, refer to the Notice of Action (NOA) that you received or visit DHCS’ Medi-Cal Fair Hearing website or the California Department of Social Services’ website. Medi-Cal beneficiaries may also call to ask for a State Fair Hearing toll-free at 1-800-952-5253 (TTY 1-800-952-8349). Please note that the number can be very busy so you may get a message to call back later.​​ 

74. 如果 Medi-Cal 受益人想要举行州公平听证会，是否有时间限制？​​ 

是的，根据适用的州法律，Medi-Cal 受益人只有 90 天的时间要求举行听证会。​​ 

75. 在等待州公平听证会决定期间，Medi-Cal 受益人还能接受治疗吗？​​ 

是的。 为了继续接受被拒绝通知停止和/或改变的 Medi-Cal Rx 服务，Medi-Cal 受益人必须在 NOA 之日起十天内或在通知称您的治疗将停止或改变的日期之前（以较晚者为准）要求举行州听证会。​​ 

在申请州公平听证会时，Medi-Cal 受益人应表明他们希望在听证会过程中继续获得 Medi-Cal Rx 服务。 请注意，对案件进行裁决并将最终决定发送给 Medi-Cal 受益人可能需要长达 90 天的时间。​​ 

76. Medi-Cal 受益人可以申请加快州公平听证会吗？​​ 

是的。Medi-Cal 受益人可以提交医生出具的信件，解释等待长达 90 天可能会对他们的生命和/或健康造成风险，从而申请加快听证会。 Medi-Cal 受益人应将这封信连同听证请求一起寄出。 有关州听证会流程的更多信息，请访问 DHCS 的Medi-Cal 公平听证会网站。​​ 

77. 对于对 Medi-Cal 提供商和/或管理式医疗计划 (MCP) 做出的 Medi-Cal Rx 承保决定提出的上诉，DHCS 是否会创建一个单独的 Medi-Cal Rx 外部上诉流程，让独立的医疗专家审查决定？​​ 

No, at this time, DHCS is not exploring creating a separate independent medical review process, akin to that currently overseen by the California Department of Managed Health Care, for Medi-Cal Rx. As a reminder, Medi-Cal Rx denials for pharmacy claims will not be made by Medi-Cal providers and/or MCPs; rather, they will initially be made by MMA and reviewed by DHCS for final determination. As mentioned elsewhere in this document, Medi-Cal providers can appeal Medi-Cal Rx denials consistent with the requirements outlined in Request for Proposal #19-96125, Exhibit A, Attachment II – Scope of Work Operations – Claims Administration, applicable state law requirements, and DHCS’ policies/procedures.​​ 

78. 哪些与药房相关的申诉将通过 Medi-Cal Rx 处理？​​ 

Medi-Cal Rx 全面投入运营后，所有与药房相关的 Medi-Cal Rx 服务申诉都将通过 Medi-Cal Rx 处理，采用现有的州公平听证会流程，由加州社会服务部管理，如上文问题 #73-76所述。​​ 

79. 在 Medi-Cal Rx 全面投入运营（AOO）时或之前，卫生保健服务部 (DHCS) 如何处理 Medi-Cal 管理式医疗计划 (MCP) 受益人因 Medi-Cal MCP 提供的药房相关服务而提出的上诉？​​ 

Medi-Cal MCP 必须解决所有 Medi-Cal MCP 受益人上诉，这些上诉源于 MCP 与药房相关服务相关的决定，而对于这些服务，MCP 在 Medi-Cal Rx 完全 AOO 之时或之前面临风险。 Medi-Cal MCP 成员向管理医疗保健部提交上诉的权利（包括但不限于独立医疗审查的权利）不受 Medi-Cal Rx 的影响，这些上诉针对的是 Medi-Cal MCP 在 Medi-Cal Rx 全面 AOO 之时或之前提供的药房相关服务。​​ 

财政影响/评估​​ 

80. Did the Department of Health Care Services (DHCS) complete a fiscal analysis prior to the transition?​​ 

是的。DHCS 完成了 Medi-Cal Rx 的财务分析并公开分享了此信息。 DHCS 预计到 2023-24 年每年可节省约 3.09 亿美元的普通基金 (GF)。 DHCS 将 Medi-Cal Rx 的财政估算作为半年一次的 Medi-Cal 估算过程的一部分，并将在未来持续对财政分析提供必要的调整（如有）。​​ 

81. 到 2023-24 年，我们预计每年将节省 3.09 亿美元的普通基金 (GF)，其中包括哪些内容？​​ 

预计到 2023-24 年将节省 3.09 亿美元的 GF 成本，包括但不限于以下因素：​​ 

• 由于药物使用从管理式医疗服务体系转向按服务收费服务体系而产生的额外的国家补充药物回扣。​​ 
• 对具有三 (3) 个或更多通用等效选项的药品实施最高允许成分成本 (MAIC)。​​ 
• 降低各种 Medi-Cal 管理医疗计划 (MCP) 使用的多个药房福利管理人员的管理职能相关的成本。​​ 
• Medi-Cal 按服务收费报销方法，其中包括 10.05 美元/13.20 美元的配药费。​​ 
• 2021-22 年预算中包括了一项针对非医院 340B 诊所的新补充付款，该付款将于 Medi-Cal Rx 于2022年 1 月1日全面投入运营后生效。 请参阅上面的问题#70 以了解更多信息。​​ 

如上文第 80 个问题所述，对 Medi-Cal Rx 财政估算的任何调整（包括储蓄预测）都将作为半年一次的 Medi-Cal 估算过程的一部分进行更新。​​ 

杂项/其他信息​​ 

82.Medi-Cal Rx 是否包括邮购药房选项？​​ 

是的。Medi-Cal 可通过 Medi-Cal Rx 提供邮购服务。 如果药房是注册的 Medi-Cal 药房提供商，则药房可以在现场或通过邮购服务分发药物。 卫生保健服务部 (DHCS) 确保为 Medi-Cal 药房服务继续提供有效的邮购服务选项。​​ 

83. 卫生保健服务部 (DHCS) 是否公开 Medi-Cal 药房补充药物回扣合同？​​ 

不是。州法律和联邦法律都保护补充药品回扣合同的保密性。​​ 

84.Medi-Cal Rx 承包商是否需要与当前网络中的现有药房签订合同？​​ 

不，Magellan Medicaid Administration, LLC (MMA) 不与任何提供商签订合同。 所有提供商注册活动以及 Medi-Cal 药房网络的维护均由卫生保健服务部 (DHCS) 负责。​​ 

84.有多少家活跃的、拥有加州执照的药店参加了 Medi-Cal 的按服务收费计划？​​ 

根据 2023 年 1 月卫生保健服务部 (DHCS) 的数据，6,547 家加州持牌药房服务提供商加入了 Medi-Cal 收费服务计划。​​ 

85. Medi-Cal 是否致力于招募属于管理式医疗计划 (MCP) 网络但未参加 Medi-Cal 收费服务的药房？​​ 

Since Medi-Cal Rx’s full Assumption of Operations (AOO) on January 1, 2022, Medi-Cal Rx uses Medi-Cal’s extensive statewide network of pharmacies that are enrolled as Medi-Cal providers. Medi-Cal enrolled pharmacies account for the vast majority of all California-licensed pharmacies. Medi-Cal MCPs currently use these same pharmacies as well as some additional pharmacies not yet enrolled as Medi-Cal pharmacy providers. The Department of Health Care Services (DHCS) has analyzed the MCP pharmacy networks, identified potential gaps where pharmacies are providing services in managed care but are not enrolled in fee-for-service, and has sent notices to those pharmacies reminding them they must enroll as a Medi-Cal pharmacy provider to continue to serve the Medi-Cal population through Medi-Cal Rx as of full AOO.​​ 

86.Medi-Cal 管理式医疗计划 (MCP) 和其他实体将以什么身份参加 Medi-Cal 全球药物使用审查 (DUR) 委员会和其他由卫生保健服务部 (DHCS) 主导的药房委员会的会议？​​ 

目前以及正在进行的过渡后，DHCS 希望其 Medi-Cal MCP 和其他相关方将根据需要继续参加与 Medi-Cal 全球 DUR 董事会和其他 DHCS 驱动的药房委员会相关的会议。 此外，DHCS 正在持续积极地评估和评定如何更有效地与 Medi-Cal MCP 和其他实体进行接触和合作，以讨论和决定未来有关 Medi-Cal 药房政策的事情。​​ 

87. 卫生保健服务部 (DHCS) 是否有与 Medi-Cal Rx 相关的更新和新闻的订阅服务？​​ 

Yes, it is called the Medi-Cal Rx Subscription Service (MCRxSS). All interested parties are encouraged to sign up for MCRxSS to receive news and updates related to Medi-Cal Rx.​​