Redirect to New Medi-Cal Rx Website and Medi-Cal Rx Subscription Service

July 22, 2020

The Department of Health Care Services (DHCS) began publishing articles regarding the Medi-Cal Rx program in April 2020. This is the fourth article in the series. The intent of these articles is to ensure Medi-Cal providers, and other interested parties, are better informed as to the upcoming Medi-Cal Rx transition.

The Medi-Cal Rx transition of all administrative services related to Medi-Cal pharmacy benefits billed on pharmacy claims from the existing intermediaries, Medi-Cal Fee-for-Service (FFS) or Managed Care Plans (MCPs), to the new Medi-Cal Rx vendor, Magellan Medicaid Administration, Inc. (Magellan), goes into effect January 1, 2021.

New Medi-Cal Rx Site Launch

The new Medi-Cal Rx site launched in June and is currently available with limited information at www.Medi-CalRx.dhcs.ca.gov. In the coming months various tools and resources will be made available on the public site to help all audiences navigate the new Medi-Cal Rx program. The public website will also provide contact information for the Medi-Cal Rx Customer Service Center.

Medi-Cal Rx Subscription Services Available

The new Medi-Cal Rx site includes an email subscription service. The Medi-Cal Rx Subscription Service (MCRxSS) is a free service that keeps the public up to date on the latest Medi-Cal Rx news. Subscribers will receive subject-specific emails for urgent announcements and other updates shortly after they are posted to the Medi-Cal Rx website. Individuals can sign up for this service at the following address:
https://mcrxsspages.dhcs.ca.gov/Medi-CalRxDHCScagov-Subscription-Sign-Up

The table below illustrates the content available now on the Medi-Cal Rx site and the features that are coming soon:

Available Now
Medi-Cal Rx Program Information
Medi-Cal Rx Subscription Service
FAQs

Coming Soon
Feature Description
Find a Pharmacy Tool Users can locate Medi-Cal enrolled pharmacies in their specified radius and custom search criteria.
Drug Lookup Tool Provides coverage information, prior authorization requirements, quantity limitations and generic/brand indications.
Medi-Cal Contract Drug (CDL) List Categorized by drug class, contains dose and strength information, along with coverage restrictions and will be searchable.
Drug Use Review (DUR) Information Page Contains comprehensive communication around the DUR program.
Provider Materials Provider Bulletins for targeted pertinent news and information. Provider Manuals will contain information needed for claims processing.
System Status Information All system issues will be reported in real-time for planned and unplanned occurrences.
Forms and Information Beneficiaries can easily access forms and information related to their pharmacy benefit.
Glossary Provides easy explanations for many pharmacy and health related terms.

 

Medi-Cal providers (including but not limited to pharmacies and prescribing physicians) will have access to a secure provider portal in addition to the public Medi-Cal Rx website. The provider portal will include the following functionalities:

  • Beneficiary Eligibility Lookup – Users can securely inquire on beneficiary eligibility status.

  • Web Claims Submission – Users can securely search for claims by cardholder ID and fill date. This tool will also allow users to submit pharmacy claims including reversals and resubmission.

  • Prior Authorization Submission and Inquiry – Pharmacies and prescribers will be able to log in to a secure section of their portal to submit prior authorization requests (PAs). Using a unique identifier, they will also be able to check the status of authorizations they have previously submitted through the portal and attach documentation to prior authorization submissions through Point of Service (POS).

  • Learning Management System – The training and learning platform will ensure users have access to appropriate, secure training so they can fully utilize the tools and resources offered.

  • Secure Message Center – The secure message center will provide the ability to send and receive messages with customer service representatives to address questions providers may have.

  • Secure Chat – Providers will be able to connect to a customer representative via the live chat option from the secured Medi-Cal Rx provider portal.

Resources

For additional and ongoing updates regarding this transition, please visit the new Medi-Cal Rx website or you can also visit the DHCS Medi-Cal Rx: Transition website. For general questions relating to Medi-Cal Rx, please direct your comments and questions to RxCarveOut@dhcs.ca.gov.

Lastly, providers are urged to start engaging any business partners (e.g. billing agents, switches, clearinghouses) that need to be aware of this transition and direct them to applicable resources as they become available.