Starting March 24 Medi-Cal Rx PA requirements reinstated for NCPDP Reject CODE 75

As of March 24, 2023, Medi-Cal Rx will initiate the first of a series of transition policy lifts for Standard Therapeutic Classes (STCs) for beneficiaries 22 and older (Phase III, Lift 1). Prior authorization (PA) requirements will be reinstated for NCPDP Reject CODE 75 – Prior Authorization Required.  

For full details, please review the Feb. 23 notification from DHCS. You can also keep up to date on Medi-Cal reinstatement on the Medi-Cal Rx Education and Outreach webpage.

** Listed HIC3s fall within STCs 07, 47, and 48; other drugs within these STCs are not impacted by this transition lift. Refer to the Medi-Cal Rx Approved NDC List for additional detail. 

How to submit a PA for P3/L1 changes 

If a beneficiary is currently receiving a medication in the STCs that are impacted by P3/L1 as outlined in the table above, consider the following in preparation for the retirement of the Transition Policy:  

1. Consider covered therapies that may not require prior authorization (PA), if clinically appropriate. 

Resources:  

• Medi-Cal Rx Contract Drugs Lists & Covered Products Lists  
• Medi-Cal Rx Approved NDC List  
• Refer to your ePrescribing application 

2. If a change in therapy is not appropriate, submit PA requests beginning February 24, 2023.

Submission methods:  

• CoverMyMeds® 
• Medi-Cal Rx Secured Provider Portal  
• NCPDP P4 Transaction  
• Fax or mail 

 Additional resources 

• Medi-Cal Rx Reinstatement of Prior Authorizations and Retirement of the Transition Policy: Phases II, III, and IV  

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].