Pharmacy Services

CenCal Health is committed to providing consistent, compassionate, and local support to all CenCal Health providers and members.

CenCal Health's Pharmacy Team is comprised of Pharmacist and Pharmacy Technician staff. Our Pharmacy Team is ready to assist our provider network and membership with pharmacy-related inquires and education. 

DHCS-Medi-Cal Rx: Medi-Cal Pharmacy Benefit

  

Effective January 1, 2021, CenCal Health members will obtain their Medi-Cal pharmacy benefit through a new system. The Department of Health Care Services (DHCS) has given this new system the name, Medi-Cal Rx. Medi-Cal Rx will be administered through DHCS and its vendor, Magellan Medicaid Administration. Magellan will provide a comprehensive suite of administrative services as directed by DHCS, which include claims management/adjudication, prior authorization, utilization management, and customer/support. 

Medi-Cal Rx is now responsible for administering the following when billed by a pharmacy on a pharmacy claim: 

  • Covered Outpatient Drugs, including Physician-Administered -Drugs (PADs)
  • Medical Supplies
  • Enteral Nutritional Products

Additional information regarding Medi-Cal Rx can be found in the "Medi-Cal Rx News" tab below and directly from the DHCS Medi-Cal Rx web site

 


CenCal Health Pharmacy Services: Medical Pharmacy Management

Effective January 1, 2021, CenCal Health and the Pharmacy Services Team will be responsible for a variety of activities including, but not limited to: oversight of clinical pharmay adherence, Drug Utilization Review (DUR) and all utilization management associated with pharmacy services (Physician-Administered-Drug) billed on a medical and institutional claim. CenCal Health defines the utilization management of Physician-Administered-Drugs on the medical benefit as Medical Pharmacy Management. 

Additional information and education resources for CenCal Health's Medical Pharmacy Management Program can be found on our Medical Pharmacy Management page. 

 

 

 

 

 

Medi-Cal RX Transition 2021

Medi-Cal Rx Support Services

The following document will provide the processing information for Medi-Cal Rx (i.e. BIN & PCN) and additional payer information. 

Medi-Cal Rx Support Services and Key Payer Sheet Details 

Pharmacies requesting additional operational claims support please contact-

Medi-Cal Rx Customer Service Center at: (800) 977-2273

 


















































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































Physician-Administered-Drugs

Physician Administered Drug Update: Preferred Biosimilars Effective 1/1/2021

Preferred Biosimilars

Physician Administered Drug Update: New Treatment Authorization Request (TAR) Requirements Effective 10/1/2020

Medical Pharmacy Benefit Physician Administered Drug Update


















































































New Pharmacist Services

New Pharmacist Services as a CenCal Health Benefit 

CenCal Health will be adding the ability for Pharmacies to bill for specific clinical services rendered by a pharmacist.  All added services follow California Assembly Bill 1114, which outlines the specified pharmacist services that are a reimbursable Medi-Cal benefit when rendered to a Medi-Cal Managed care member in the outpatient pharmacy setting.  CenCal Health would like to solicit initial interest for provider participation during August and September before implementation of the program. 

Please see the initial details for the new program below:  

  • Eligible Members 
    • A patient who has active CenCal Health enrollment for the date of service
    • Eligible Pharmacist Services
  • Eligible Pharmacist Services
    • Furnishing travel medications
    • Furnishing self-administered hormonal contraception
    • Initiating and administering immunizations
    • Providing tobacco cessation counseling and furnishing nicotine replacement therapy
  • Accepted Billing Code
    • Evaluation and Management (E&M) billing codes:
      • 99201-New patient
      • 99212-Established patient
    • Administration billing code:
      • 90471-Vaccine administration

For further information on the above program, or if you would like to inquire about becoming contracted with CenCal Health to provide the above service, please contact the CenCal Health Pharmacy Department at (805) 562-1080.

 

 

See below for Pharmacy Services News