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Draft Proposal for Comment: Coverage Policies for Prescription Drugs

September 2, 2016

The Department of Health Care Services (DHCS) is required to adopt regulations by October 1, 2017, related to the implementation of statewide coverage policies for prescription drugs, pursuant to Senate Bill 870 (Chapter 40, Statutes of 2014).

The goal of this proposed regulatory action is to establish a financially sustainable, value-based framework that facilitates uniform access to certain prescribed drugs for all Medi-Cal recipients at the lowest cost to the Medi-Cal program.

This proposed regulatory action will address the Medi-Cal policy and procedures to operationalize the programmatic functions for certain prescribed drugs subject to statewide coverage policies.

The proposed statewide coverage policies will apply to the entire Medi-Cal program, including fee-for-service, Medi-Cal Managed Care Plans and County Organized Health System (COHS) Plans.

DHCS encourages early public participation to improve the quality of the final proposed pharmacy regulations. Comments and feedback will be considered as part of the development of the final proposed regulatory text.

Written comments and feedback should be submitted to the Department no later than close of business on October 14, 2016.

A copy of the proposed draft document, “SB 870 – Feedback Request: Draft Policies for Prescription Drugs,” can be accessed  by users who navigate to the “Hot Topics” section of the Pharmacy Benefits Division page of the DHCS website.