MedicaidReimbursementMedium impact
24-953m 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, pharmacists can now be reimbursed for administering ACIP-recommended vaccines through either Medi-Cal Rx or by billing medical claims directly to CalViva Health. All ACIP-recommended vaccines must be covered without prior authorization or member cost-sharing, with retroactive reimbursement back to January 1, 2023.
Action Required
Immediately: Billing team must update workflows to accept and process pharmacy administration claims for ACIP-recommended vaccines through medical billing in addition to Medi-Cal Rx. Ensure no prior authorization requirements are applied to ACIP-recommended vaccines. Update billing systems to process retroactive claims back to January 1, 2023 for vaccine administration fees.