Prior authorization request form Form

Questions? Please call Magellan at the Medi-Cal Rx Customer Service Center (CSC) Toll-Free: 1.800.977.2273 www.medi-calrx.dhcs.ca.gov RX_MCAL RX TRNSTN POLICY 02/2023 Important Reminder: Medi-Cal Rx Transition Policy will be Retired Beginning Friday, March 24, 2023.

At Alameda Alliance for Health (Alliance), we value our dedicated provider community. We have an important reminder we want to share with you. Starting on Friday, March 24, 2023, Medi-Cal Rx will begin a series of transition policy lifts for Medi-Cal beneficiaries 22 years of age and older. A transition lift is the retirement of the Transition Policy for named Standard Therapeutic Classes (STCs). Prior authorization (PA) requirements will apply to certain drugs affected by the first transition lift. For beneficiaries 22 years of age and older who were receiving medication through the Transition Policy (i.e., due to historical paid claims data or grandfathered PAs that are expiring), the prescription will now be subject to Medi-Cal Rx PA requirements if the medication is named in the transition lift. What can providers do to help patients with this transition? • Consider transitioning beneficiaries 22 years of age and older to covered alternatives that may not require PA. • If a covered alternative is not appropriate, you can submit a PA request to Medi-Cal Rx starting on Friday, February 24, 2023. • You can confirm if Magellan covers a medication on the Contract Drugs List (CDL) at https://medi-calrx.dhcs.ca.gov/home/cdl. • If a change in therapy is not appropriate, please consider planning ahead by submitting a PA request to Magellan starting on Friday, February 24, 2023.
Please note:
• Early submission of PA requests for beneficiaries under 22 years of age will not be accepted at this time.
• Early submission of PA requests for enteral nutrition products will not be accepted at this time. Questions? Please call the Medi-Cal Rx Customer Service Center (CSC) toll-free at 1.800.977.2273, available 24 hours a day, 7 days a week, 365 days r year. For other questions, please email Medi-Cal Rx Education & Outreach at medicalrxeducationoutreach@magellanhealth.com.