MedicaidReimbursementMedium impact
24-955m Changes to Pharmacy Administration Reimbursement for ACIP-Recommended Vaccines
Health Net·CA · Family Medicine, Internal Medicine, Pediatrics·Prior Authorization
Effective date
Aug 1, 2024
We identified it
Jun 20, 2026
Summary
Effective August 1, 2024, pharmacists can now be reimbursed for administering ACIP-recommended vaccines through either Medi-Cal Rx or by submitting medical claims directly to Health Net. This eliminates prior authorization requirements for all ACIP-recommended adult vaccines and provides retroactive reimbursement back to January 1, 2023.
Action Required
Immediately: Update billing workflows to accept pharmacy administration claims for ACIP-recommended vaccines submitted as medical claims instead of pharmacy claims. Billing team must verify that all ACIP-recommended adult vaccines are processed without prior authorization requirements. Contact Health Net Provider Services at 800-675-6110 for questions about claim submission options.