Medi-Cal Pharmacy (Rx) Reminder – Retirement of Historical Extended Duration Prior Authorizations Policy
| Date: | November 04, 2026 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) |
| To: | All Health Plan Practitioners, Facilities, and Hospitals |
| Type: | Informational/Educational |
| Subject: | Medi-Cal Pharmacy (Rx) Reminder – Retirement of Historical Extended Duration Prior Authorizations Policy |
| Business: | Medi-Cal Managed Care |
Effective November 30, 2026, a reminder that Medi-Cal Rx will no longer apply the extended duration prior authorization (PA) policy to certain maintenance medications. The policy was activated to support California Code of Regulations (CCR), Title 22, Section 51003(e). This policy will now be retired. All historically approved PAs that have an expired date will be deactivated, including those approved by the previous managed care plans (MCP).
For medication claims within this policy submitted on or after November 30, 2026, will require a prior authorization to be resubmitted and be reviewed for medical necessity.
The claims will reject with Reject Code 75 – Prior Authorization Required. Medi-Cal Rx preference is to change the medication to a covered alternative. You can refer to the Contract Drugs & Covered Products Lists for covered drugs or submit a PA for medical necessity review.
For additional detailed information and the affected drug list, please visit weblink: https://medi-calrx.dhcs.ca.gov/cms/medicalrx/static-assets/documents/provider/2026/10_A_30-Day-Countdown_Retiring_Historical_PAs.pdf
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org
