Providing Medications for Medi-Cal Recipients Impacted by State of Emergency

Note: This notice is posted on behalf of the Department of Health Care Services.

On October 28, 2019, in response to the Governor’s recent proclamation of a statewide state of emergency due to the risk of wildfires, the Department of Health Care Services (DHCS) issued guidance for dispensing replacement medication(s) to recipients impacted by fires and extreme fire weather conditions or public safety power shutoff. This is an update to that guidance.

Providers are instructed to incorporate the statement “Patient impacted by fires and extreme fire weather conditions or public safety power shutoff” within the Miscellaneous Information field on the Treatment Authorization Request (TAR) for those drugs or situations requiring a TAR.

Pharmacy providers must dispense the full amount of the requested medication immediately if the need to dispense is related to the recipient’s displacement or subjection to fires and extreme fire weather conditions or public safety power shutoff, and not have the recipient return after receiving TAR approval. The need for a TAR should not negatively affect the decision to dispense the full amount of the required medication immediately and the TAR can be submitted retrospectively. It is imperative that the impacted patient receive the full amount of the necessary medication in a timely manner to facilitate compliance and to not cause a delay or break in therapy.

TARs for medications (new, refill or replacement) will be automatically approved if the TAR indicates that the recipient is impacted by fire, or by power shutoffs, and the provider will be paid for the claim for the dispensed medications. The negative impact of the fire or power shutoff, alone, will meet the criteria of medical necessity.

Providers are encouraged to monitor the Medi-Cal website for future updates. Questions regarding this notice may be directed to the Telephone Service Center (TSC) at 1-800-541-5555 Monday through Friday, except holidays.