MedicaidReimbursementMedium impact
24-954m Changes to Pharmacy Administration Reimbursement for ACIP-Recommended Vaccines
Health Net·CA · Family Medicine, Internal Medicine, Pediatrics +1 more·Prior Authorization
Effective date
Aug 1, 2024
We identified it
Jun 20, 2026
Summary
Effective August 1, 2024, pharmacies can now bill for ACIP-recommended vaccine administration through either Medi-Cal Rx or directly to Health Net as medical claims. All ACIP-recommended vaccines must be covered without prior authorization or member cost-sharing for children and adults.
Action Required
Immediately: Update billing workflows to accept pharmacy administration claims for ACIP-recommended vaccines through medical billing (as alternative to Medi-Cal Rx). Billing team must ensure no prior authorization requirements are applied to ACIP-recommended vaccines and no cost-sharing is charged to members. Verify eligibility through provider portal at 833-236-4141 for questions.