MedicaidAdministrativeHigh impact
20-802 Alert: Medi-Cal Managed Care Pharmacy Benefit Carve-Out and Transition to Medi-Cal Rx
Health Net·CA·Prior Authorization
Effective date
Apr 1, 2021
We identified it
Jun 20, 2026
Summary
Medi-Cal pharmacy benefits are transitioning from Health Net managed care to Medi-Cal Rx administered by Magellan, effective April 1, 2021 (delayed from January 1, 2021). Providers must now work directly with Magellan for pharmacy prior authorizations, claims adjudication, and pharmacy-related services for Medi-Cal members in specified counties.
Action Required
By April 1, 2021: All providers serving Medi-Cal members in Kern, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties must contact Magellan to establish Medi-Cal Rx provider training and set up required accounts. Update billing workflows to direct pharmacy prior authorizations to Magellan instead of Health Net for services on/after April 1, 2021. Train staff on new member contact numbers: Medi-Cal Rx Call Center at 1-800-977-2273 for pharmacy issues. Failure to transition will result in delays in pharmacy service approvals.