Medi-Cal Rx implementation slated for January 2022

The California Section of Well being Care Companies (DHCS) announced previous week it will put…

The California Section of Well being Care Companies (DHCS) announced previous week it will put into practice its postponed Medi-Cal Rx software in January 2022. The announcement arrived immediately after DHCS approved a Conflict Avoidance Approach submitted by the program’s seller, Magellan Medicaid Administration (MMA), a subsidiary of Magellan Wellness, Inc.

The Medi-Cal Rx plan — the outcome of a 2019 govt order from Gov. Gavin Newsom — was in the beginning slated to be executed on Jan. 1, 2021, but has hit numerous roadblocks. In January 2021, Centene Corporation announced its acquisition of Magellan, which the state experienced preferred as its vendor for Medi-Cal Rx services.

 

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This raised conflict of fascination fears for DHCS considering that Centene operates managed care ideas and pharmacies that participate in Medi-Cal. Just after originally delaying implementation to April 1, 2021, DHCS delayed the start out date indefinitely in February right after obtaining conflict avoidance protocols from Magellan.

Following reviewing these protocols, DHCS deemed Magellan’s system met the two major conflict avoidance demands the division had discovered: that MMA just can’t share proprietary facts on users with Centene and that Centene just cannot be included in prior authorization or claim approvals and payments to its six specialty pharmacies that participate in Medi-Cal.

The office also summarized the principal characteristics of the Conflict Avoidance Plan as follows:

  • If Centene acquires Magellan, and for so extensive as Magellan is below agreement to DHCS, the operations, staffing, details technology programs, and knowledge of MMA will be held absolutely individual from Centene’s wellness system enterprise line. This dedication is affirmed by Centene
  • A 3rd-social gathering check selected by DHCS will be in spot to be certain this organizational separation is managed and
  • DHCS will cope with all elements of statements processing and authorization for the Centene-owned pharmacies and MMA will integrate these types of system-large facts as required for DHCS to run analytics in assistance of top quality assurance and software integrity for these promises. The DHCS do the job efforts will not result in State Standard Fund prices.

Part of the state’s CalAIM initiative, the system will transition Medi-Cal pharmacy products and services from a managed treatment shipping method to a payment-for-services product. It incorporates approximately 94% of California’s pharmacies and aims to improve Medi-Cal beneficiaries’ access to pharmacy companies by utilizing a standardized, statewide supply method.

The system will also implement utilization administration protocols to all outpatient medications and allow for the state to greater negotiate supplemental drug rebates with companies.