Starting Sept. 22, 2023, the California Department of Health Care Services (DHCS) is reinstating prior authorization (PA) requirements for new start enteral nutrition products for members ages 22 years and older.
Do not submit PA requests before Sept. 22 for enteral nutrition products that will require a PA.
Please note:
- PA requests submitted before Sept. 22 will be returned with a message that no PA is required. Please submit PA requests beginning Sept. 22.
- PA requirements for enteral nutrition products for members 21 years of age and younger will not be reinstated prior to 2024.
You can submit a PA request via one of the approved Medi-Cal Rx submission methods:
- CoverMyMeds®.
- Medi-Cal Rx Secured Provider Portal.
- Fax.
- U.S. Mail.
Refer to the List of Contracted Enteral Nutrition Products for products that are eligible for coverage and reimbursement, subject to an approved PA, under Medi-Cal Rx when billed by Medi-Cal Rx eligible pharmacy providers.
For more information on this transition, please refer to the 90-day countdown notification from DHCS.
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].
