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Medi-Cal Rx update: all prior authorization requirements reinstated

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As of November 10, 2023, the Medi-Cal Rx Transition Policy has been retired for all pharmacy benefits for members 22 years of age and older. Note that members 21 years of age and younger will not be impacted at this time.

Prior authorization (PA) requirements have been reinstated for all therapies for standard therapeutic classes, including enteral nutrition products. Brand Medically Necessary (BMN) PA requirements are reinstated for all claims.

As part of this phase of the transition policy, the drug classes below now require a PA.

Phase IV, Lift 4 Drug Classes
Protein Lysates Infant Formulas Electrolytes and Miscellaneous Nutrients

What pharmacy providers and prescribers need to do

For more details and resources, see the Oct. 10 DHCS announcement.

Questions?

You can call the Medi-Cal Rx Customer Service Center at 800-977-2273, which is available 24 hours a day, 7 days a week. You can also email Medi-Cal Rx Education & Outreach at [email protected].