Provider Alerts

Beginning January 1, 2022, Health Plan of San Joaquin pharmacy benefits will be transitioned to and administered by the new California State agency, Medi-Cal Rx. Medi-Cal Rx is responsible for adjudicating all outpatient pharmacy drugs. DHCS has partnered with Magellan Health to provide this benefit and support Medi-Cal Rx.

Some outpatient medications for certain conditions, like cancer, will require special handling, administration, and monitoring. These are supplied by specialty pharmacies or may be available at a local retail pharmacy. Details will be provided by Magellan and DHCS.

There are four things HPSJ providers must do now:

1. Register and receive training from DHCS for the secure Medi-Cal Rx Provider Web Portal, https://medi-calrx.dhcs.ca.gov/home.
2. Review online www.Medi-CalRx.dhcs.ca.gov:
   • Medi-Cal Rx Pharmacy Transition Policy
   • Contract Drug List (CDL)
   • List of covered pharmacy providers
3. Create a plan for your HPSJ patients’ medications starting January 1, 2022. The Department of Health Care Services has created a transition plan to ensure that coverage for beneficiaries’ medication will continue from January 1, 2022. This includes submission of prior authorizations for outpatient pharmacy drugs to Medi-Cal Rx starting on January 1, 2022. Fax prior authorization requests to 1.800.869.4325.
4. Call if you have questions: Medi-Cal Rx Call Center Line, 1.800.977.2273 TTY/ TDD 711, 24/7, or visit www.Medi-CalRx.dhcs.ca.gov

DHCS will send information to HPSJ patients and Medi-Cal providers including pharmacies before January 1, 2022.

For additional information and to contact pharmacies to get specialty medications, please see the attached Pharmacy-Carve-Out Factsheet.

Download Provider Alert Attachment