Medi-Cal Pharmacy Professional Dispensing Fee Provider Self-Attestation
6/20/2023
Medi-Cal Pharmacy Provider Self-Attestation Period Now Closed
The online attestation portal for Fee-for-Service (FFS) Medi‑Cal pharmacy providers seeking the higher of two professional dispensing fees as part of the reimbursement changes for covered outpatient drugs closed at 11:59 p.m. on March 31, 2023. No additional attestations, or changes to submitted attestations, will be accepted.
As published in previous Medi‑Cal updates, the Department of Health Care Services (DHCS) implemented a new FFS reimbursement methodology for covered outpatient drugs. Part of this methodology is a two-tiered professional dispensing fee based on a pharmacy provider’s total (Medi‑Cal and non-Medi‑Cal) annual pharmacy claim volume:
• Fever than 90,000 claims per year : $13.20
• 90,000 or more claims: $10.05
Reporting the claim volume via the Claim Volume Report is a self-attestation process. The Claim Volume Report will be submitted electronically and must be repeated annually.
Note: DHCS policy stipulates that a claim is equivalent to a dispensed prescription; therefore, the attestation is for the total dispensed prescription volume.
Only FFS Medi‑Cal pharmacy providers dispensing fewer than 90,000 total prescriptions per calendar year are eligible to receive the higher of the two professional dispensing fees. Qualified providers must complete this attestation in order to receive it.
The attestation for the 2022 calendar year reporting period will determine the professional dispensing fee component of the pharmacy claim reimbursement for claims with dates of service within the state’s following fiscal year (dates of service from July 1, 2023 through June 30, 2024).
Please ensure to keep your contact information up-to-date across all organization involved in pharmacy administration including, but not limited to, Medi-Cal, the Board of Pharmacy, National Plan and Provider Enumeration System (NPPES) and National Council for Prescription Drug Programs (NCPDP). It is strongly encouraged that all stakeholder subscribe to the Medi-Cal Rx Subscription Service (MCRxSS) to ensure they are receiving timely notifications pertaining to the pharmacy self-attestation surveys.
For more information about Medi-Cal Rx, please visit DHCS’ dedicated Medi-Cal Rx website:
https://www.dhcs.ca.gov/provgovpart/pharmacy/Pages/Medi-CalRX.aspx
General Medi-Cal Rx Frequently Asked Questions — additional guidance and clarification to Medi-Cal beneficiaries, providers, plan partners, and other interested parties:
https://www.dhcs.ca.gov/provgovpart/pharmacy/Documents/Medi-Cal-Rx-FAQ-V-5-1-12-2021.pdf
Pharmacy Provider Self-Attestation Frequently Asked Questions:
https://files.medi-cal.ca.gov/pubsdoco/ncpdp/Pharmacy_Provider_Self-Attestation_faq.aspx
Magellan and Mercer hosted a webinar on February 23, 2023 to walk through the self-attestation process and answer any questions you may have.
The recording of the webinar can be found here: https://magellanhealth.zoom.us/rec/share/nGkYmvR9ZGVHsdp_duclRONIvOrF4OQrmjjIxMDSbWKXO8ofMQqQXhI2f-F_LNoH.ONZNHebUjVrrmqPo
You may download the webinar slides here: Webinar Slide pdf