Medi-Cal Pharmacy (Rx) – 30-Day Countdown: Prior Authorization Policy Updates
| Date: | July 22, 2026 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) |
| To: | Health Plan Practitioners, Facilities, and Hospitals |
| Type: | Informational/Educational |
| Subject: | Medi-Cal Pharmacy (Rx) – 30-Day Countdown: Prior Authorization Policy Updates |
| Business: | Medi-Cal Managed Care |
Effective August 3, 2026, this is a reminder that Medi-Cal Rx will no longer apply the extended duration prior authorization (PA) policy to certain medications and drug classes. The claims will deny with Reject Code 75 – Prior Authorization Required.
Medi-Cal Rx’s preference is changing the medication to a covered alternative. You can refer to the Contract Drugs & Covered Products Lists for covered drugs. A PA request may be submitted to Medi-Cal Rx for review and consideration for use of non-covered medications.
For different ways that you can submit a PA to Medi-Cal Rx, please visit weblink: https://medi-calrx.dhcs.ca.gov/cms/medicalrx/static-assets/documents/provider/forms-and-information/Medi-Cal_Rx_CoverMyMeds_Flyer.pdf
For additional detailed information and the impacted drugs list, please visit weblink: https://medi-calrx.dhcs.ca.gov/cms/medicalrx/static-assets/documents/provider/2026/07_A_30-Day_Countdown_PA_Policy_Updates_Aug_3_2026.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
