DHCS is restoring prior approval for certain drugs on September 16


August 23, 2022

On September 16, 2022, prior authorization (PA) requirements will be reinstated for 11 drug classes for new starter drugs for Medi-Cal beneficiaries age 22 and older.

Earlier this year, the California Department of Health Care Services (DHCS) began waiving prior approvals from the Medi-Cal Rx program to minimize disruptions in patient access to prescription drugs due to challenges in transitioning Medi -Cal Rx occurred.

In the first of the three reinstatement phases, claims processes were activated for drug use review processing effective July 22, 2022. DUR Rejection Code 88 alerts are triggered by cases such as drug interactions, high doses, early refills, etc. PA Requirements will be reinstated for certain drug classes from September 16, 2022.

To help physicians understand the Medi-Cal Rx phased implementation plan, the California Department of Health Care Services (DHCS) has published a reference guide for reinstatement after prior approval.

Keep up to date with the latest Medi-Cal Rx news by signing up for the Medi-Cal Rx subscription service. If you have any questions, please contact the Medi-Cal Rx Customer Service Center at (800) 977-2273, available 24 hours a day, 365 days a year, or email [email protected]

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