MedicaidAdministrativeHigh impact
20-803 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 managed care plans (Health Net/CalViva Health) to state-administered Medi-Cal Rx program managed by Magellan, effective April 1, 2021 (delayed from January 1, 2021). Providers must now work directly with Magellan for all pharmacy-related prior authorizations, claims, and issues for Medi-Cal members in Fresno, Kings, and Madera counties.
Action Required
By April 1, 2021: Contact Magellan to establish required Medi-Cal Rx provider training and setup. Update billing workflows to submit all pharmacy claims directly to Magellan instead of Health Net/CalViva Health. For pharmacy prior authorizations after April 1, 2021, engage with Magellan directly rather than the managed care plans. Train staff on new contact numbers: Medi-Cal Rx Call Center at 1-800-977-2273 for member issues. Failure to transition will result in pharmacy claim processing delays and denials.