On May 19, 2023, Phase III, Lift 3 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 22 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 May 19, prior authorization requirements will be reinstated for the following drug classes:
|Phase III, Lift 3 Drug Classes
|Anti-Ulcer Preps/ Gastrointestinal Preps
|Fat Soluble Vitamins
|Folic Acid Preparations
|General Antibacterials and Antiseptics
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, pharmacy providers and prescribers can consider the following options:
- Consider covered therapies that may not require a PA, if clinically appropriate. Review the following:
- Medi-Cal Rx Contract Drugs Lists & Covered Products Lists.
- Medi-Cal Rx Approved NDC List.
- Prescribers: Refer to your ePrescribing application.
- If a change in therapy is not appropriate, submit a PA request via one of the approved Medi-Cal Rx submission methods:
You can find additional resources for Phase III, Lift 3 in the April 19 DHCS notification.
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].