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New Pharmacy Benefit and Six-Prescription Limit Temporarily Suspended

May 14, 2020

The Department of Health Care Services (DHCS) continues to closely monitor the 2019 novel Coronavirus (COVID-19) situation and provide updates and guidance to Medi-Cal providers in response to concerns or questions related to the Medi-Cal fee-for-service (FFS) and Family PACT pharmacy benefit. Therefore, pursuant to the federally approved State Plan Amendment 20-0024, the six-prescription limit set forth in Welfare and Institutions Code (W&I Code), section 14133.22 is temporarily suspended. However, claims will not process until system changes are complete. DHCS will temporarily allow pharmacy providers to dispense and bill DHCS for all medically necessary prescriptions dispensed to eligible FFS Medi-Cal beneficiaries without limitations on the number of prescriptions dispensed during the calendar month. The full policy document is published on the COVID-19 webpage at: Fee-for-Service Pharmacy: Benefit Reminders and Clarifications. This temporary change will remain in place until further notice.

Note:

Although this policy is effective, claims will not process until system changes are complete.