#PNN Prescription

Amidst growing concerns surrounding the program’s rollout, the California Medical Association (CMA) has urged the California Department of Health Care Services (DHCS) to once again delay the implementation of the Medi-Cal Rx program.

While CMA continues to support the Governor’s efforts to lower the cost of drugs for all Californians and will continue to partner with the Administration in broader health care cost-containment efforts, CMA has remained engaged in the proposed rollout, and vocal about its concerns for the potential lapse in care and benefits that would occur from implementing the program at this time while physicians are still dealing with the COVID-19 pandemic.

On February 1, 2021, CMA sent a letter to Governor Gavin Newsom expressing concerns regarding the planned implementation of his Executive Order on pharmaceuticals and its direction to carve the pharmacy benefit out of the Medi-Cal managed care benefit, potentially disrupting critical care between patients and physicians as well as benefits for millions of Medi-Cal beneficiaries.

In this letter CMA stated that DHCS’ initial delay to April 1, 2021 was insufficient to ensure a smooth and safe transition for beneficiaries. As the state continues to wrestle with the enormity of the effects of the ongoing pandemic – which are having an undue burden on our state’s health care system – CMA said further delaying the program was most logical way to preserve benefits and critical care for beneficiaries during this time.

“In a normal year, the implementation of this change would have been a significant workload,” said Dustin Corcoran, CMA CEO. “Given the constraints on our healthcare system due to the COVID-19 pandemic,  we think it is prudent to delay the implementation of this important program.”

To date, only a minutia of the tens of thousands of state prescribing providers have registered for the program, and an even smaller portion of them have received the necessary information to begin to use the proposed portal – the main mechanism that will allow providers to submit authorization requests for their patients.

Citing a lack of enrollment and education on the process for providers, CMA has recommended aligning the Medi-Cal Rx implementation with the implementation of the CalAIM initiative, and postponing implementation until such time as the CalAIM transition occurs and a significant majority of Medi-Cal prescribers have registered and are trained to use the Medi-Cal Rx portal.

“Physicians’ offices are often the first place patients call when they have trouble getting their prescription. In many cases, while time consuming and frustrating, a physician’s office can help solve the problem by communicating with the pharmacy to make sure the patient receives their medication,” said Corcoran. “To date, there has not been any significant or meaningful provider education to help smooth this transition and we are worried that the volume of patients experiencing difficulty in getting their prescriptions will overwhelm physician practices, leading to negative health outcomes or even significant patient harm.”

Physicians are still encouraged to start the registration process as soon as possible to ensure their ability to prescribe for Medi-Cal patients is not interrupted. The first step in the registration process is to request a personal identification number (PIN), which will be sent via mail to the address on record with Medi-Cal. The letter with the PIN can take up to 10 days to arrive.

More information on the Medi-Cal Rx transition and the provider portal can be found at medi-calrx.dhcs.ca.gov/home.

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