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As of April 21, Medi-Cal Rx PA requirements will be reinstated for 17 additional drug classes

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On April 21, 2023, Phase III, Lift 2 of the Medi-Cal Rx Claim Edits and Prior Authorization Reinstatement Plan will be implemented. This part of the plan lifts the Transition Policy for 17 additional drug classes.

The phased approach for PA reinstatements enables providers to gradually submit PAs for renewing prescriptions, or to transition beneficiaries to medications and products on the Contract Drugs List (CDL) and/or Covered Products Lists.

After April 21, 2023, prior authorization requirements will be reinstated for the following drug classes:

Phase III, Lift 2 Drug Classes
Contraceptives and Hormones Ophthalmic, Nasal, and Otic Preparations Thyroid Agents Topical Anesthetic Agents
Dermatologic Agents

 

Biologic Agents Glucocorticoids and Corticotropins Anti-Parkinson’s

 

Please note:

The following are exempt from Phase III: Retirement of the Transition Policy:

  • Beneficiaries 21 years of age and younger.
  • Enteral nutrition products for beneficiaries of all ages.

What pharmacy providers and prescribers need to do

If a beneficiary is currently receiving a medication in a drug class listed in the table above, pharmacy providers and prescribers can consider the following options:

  1. Consider covered therapies that may not require a PA, if clinically appropriate. Review the following:
  1. If a change in therapy is not appropriate, submit a PA request via one of the approved Medi-Cal Rx submission methods:

For information on how to submit PA requests in advance of the Transition Policy retirement, please see the March 10 DHCS notification.

You can find additional resources for Phase III, Lift 2 in the March 21 DHCS notification.

Questions?

Call the Medi-Cal Rx Customer Service Center at 800-977-2273 (available 24/7) or email Medi-Cal Rx Education & Outreach at [email protected].