Announcement regarding Partnership HealthPlan of California (PHC) Pharmacy
Benefits and Services:
Starting January 1, 2022, PHC’s pharmacy benefit and services will be carved
out to Medi-Cal Fee-For Service (FFS) and PHC will no longer be responsible for
administering the pharmacy benefit. The pharmacy carve-out is called
Medi-Cal Rx. Medi-Cal and the Department of Health Care Services have
contracted with Magellan Medicaid Administration, Inc (MMA) to administer the pharmacy
benefits and services including pharmacy claim processing, prior authorization
review, and operating member and provider call centers.
What this means to providers and members: The PHC Medi-Cal Pharmacy Formulary is no longer available nor applicable to pharmacy claims as of Jan 1, 2022. Pharmacies will submit Medi-Cal Rx prescription claims and TARs to Magellan Medicaid Administration, Inc. (MMA). To see the Medi-Cal Rx pharmacy formulary, members and providers need to go to the State's Covered Drug List (CDL):
Medi-Cal Rx Contract Drug List (CDL) in PDF: Medi-Cal CDL
Medi-Cal Rx online searchable CDL: Search Medi-Cal CDL/Formulary
Additional Medi-Cal Rx Pharmacy Benefit Information & Resources:
Drugs Billed Directly to PHC Through the Medical Benefit:
The PHC Pharmacy Department continues to be responsible for overseeing the medical drug benefit (drugs administered directly to members by a medical provider and billed to PHC as a medical claim), also known as PADs (Physician Administered Drugs). Together with State Medi-Cal advisories, direction from the Pharmacy & Therapeutics (P&T) Committee and the Physician Advisory Committee (PAC), the PHC pharmacy department establishes coverage & TAR requirements for the PAD benefit.
Note that only medical providers (hospitals, surgery center, prescriber offices and clinics) can submit claims or TARs for drugs administered to members. Pharmacies (including infusion pharmacies) must submit drug claims to Medi-Cal Rx (Magellan Medicaid Administration, Inc.).