New and Replacement Medication for (FFS) Medi-Cal Beneficiaries Impacted by Wildfires
August 31, 2020
In response to the Governor’s recent proclamations of a statewide state of emergency, the Department of Health Care Services (DHCS) is issuing guidance for dispensing, and/or replacing, medication(s) to fee for service FFS Medi-Cal beneficiaries impacted by fires and extreme fire weather conditions or public safety power-shutoff actions.
Additionally, on August 18, 2020, the California State Board of Pharmacy released information for Licensees (https://www.pharmacy.ca.gov/about/news_release/state_of_emergency_081820.pdf) to all California Board registered pharmacists/pharmacies reminding them of general information and state laws intended to help pharmacists provide prescription drugs including controlled substances for residents affected by emergency situations.
For FFS Medi-Cal beneficiaries, if the drug being dispensed requires a Treatment Authorization Request (TAR) or Service Authorization Request (SAR), providers are instructed to incorporate the statement “Patient impacted by fires and/or extreme weather conditions or public safety power shutoff.” within the miscellaneous information field on the prior authorization request for those drugs or situations requiring a TAR or SAR.
When dispensing the requested medication, pharmacy providers must dispense the full amount of the requested medication immediately if the need to dispense is related to the beneficiary’s displacement or subjection to fires and extreme fire weather conditions or public safety power shutoff, and not have the beneficiary return after receiving TAR/SAR approval. The need for a TAR/SAR should not negatively affect the decision to dispense the full amount of the required medication immediately and the TAR/SAR can be submitted retrospectively. It is imperative that the impacted patient receive the full amount of the necessary medication in a timely manner to facilitate compliance and to not cause a delay or break in therapy.
TARs/SARs for medications (new, refill or replacement) will be automatically approved if the TAR/SAR indicates that the beneficiary is impacted by fire, or by power shutoffs, and the provider will be paid for the claim for the dispensed medications. The negative impact of the fire, weather event or power shutoff, alone, will meet the criteria of medical necessity.
Providers are encouraged to monitor the Medi-Cal website for future updates. Questions regarding this notice may be directed to the Telephone Service Center (TSC) at 1-800-541-5555, 8 a.m. to 5 p.m. Monday through Friday, except holidays.