Californians for Accessible Healthcare

In 2019, as part of his bold promise to ensure affordable, accessible healthcare for all residents, Gov. Gavin Newsom issued Executive Order EO N-01-19. Gov. Newsom has since kept this promise and, beginning on January 1, 2022, California’s Department of Health Care Services (DHCS) will transition from current Medi-Cal pharmacy services to a Fee-for-Service (FFS) model under Medi-Cal Rx. This transition allows the state to: maximize its bargaining power when negotiating with drug companies, reduce the state’s overall spending on medications, and to more broadly promote and expand access to affordable healthcare for millions of Californians by providing access through Medi-Cal Rx. Under the new Medi-Cal Rx program, beneficiaries will have access to a broader pharmacy network that includes roughly 94% of the state’s pharmacies.

Californians for Accessible Healthcare

Our pharmacists and pharmacy technicians have been at the forefront of the COVID-19 pandemic by expanding access to testing for residents, as well as distributing COVID-19 vaccines and protecting Californians against the virus. Pharmacists have been able to provide care during the current public health emergency and, through Medi-Cal Rx, patients will enjoy expanded access to healthcare services while saving money on prescription medications.

Medi-Cal Rx is aimed at improving the state’s healthcare system by providing a singular, more standardized delivery system for both beneficiaries and providers, and enabling greater accessibility to a variety of pharmacy services. All current Medi-Cal administrative and pharmacy services, such as outpatient medications (both prescription and over-the-counter), enteral nutrition technology, and medical supplies, will be billed as a pharmacy claim under the new FFS delivery system and will be made available through the Medi-Cal Rx portal.

Thank Governor Newsom

Sign the letter below to show your support in ensuring healthcare remains affordable and accessible for all.

Frequently Asked Questions

Developed by California’s Department of Health Care Services, Medi-Cal Rx is the name given to the new system of how current Medi-Cal pharmacy benefits and services will be administered under a fee-for-service delivery system.

By transitioning to a fee-for-service model, Medi-Cal pharmacy benefits will be more standardized under a singular, statewide delivery system, and beneficiaries will have greater access to pharmacy care and services through a more comprehensive pharmacy network. A fee-for-service model also strengthens the state bargaining power to negotiate supplemental drug rebates with drug manufacturers. 

The transition to Medi-Cal Rx will not affect the following services:

  • The current scope of covered Medi-Cal pharmacy benefits.
  • Pharmacy services currently provided as part of a bundled billing rate in inpatient care or long-term care settings, irrespective of delivery system. 
  • Current Medi-Cal managed care pharmacy carve-outs, including, but not limited to, HIV/AIDS medication, antipsychotics, and drugs used to treat substance disorders. 
  • Pharmacy services that are billed as a medical or institutional claim.
  • Per California state law, the State Fair Hearing process for Medi-Cal beneficiaries.

As noted in question 3, pharmaceuticals under a bundled structure in inpatient care or long-term care settings will remain unchanged under MediCal’s managed care plan. For drugs that are billed on a fee-for-service basis, the cost would be determined by the type of claim under which they are billed.

Sign Up For More Information

We encourage beneficiaries and providers to learn more about the new Medi-Cal Rx delivery system, familiarize themselves with the program’s online portal, and read about the registration process ahead of the program’s official implementation in 2022. If you would like more information on Medi-Cal Rx, please complete the form below.