California Welfare and Institutions Code 14132.968 – (a) (1) Pharmacist services are a benefit under the …
(a) (1) Pharmacist services are a benefit under the Medi-Cal program, subject to approval by the federal Centers for Medicare and Medicaid Services.
(2) The department shall establish a fee schedule for the list of pharmacist services.
Terms Used In California Welfare and Institutions Code 14132.968
- Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
- department: means the State Department of Health Services. See California Welfare and Institutions Code 14062
- Medi-Cal: means the California Medical Assistance Program. See California Welfare and Institutions Code 14063
(3) The rate of reimbursement for pharmacist services shall be at 85 percent of the fee schedule for physician services under the Medi-Cal program, except for medication therapy management (MTM) pharmacist services as described in Section 14132.969.
(b) (1) The following services are covered pharmacist services that may be provided to a Medi-Cal beneficiary:
(A) Furnishing travel medications, as authorized in clause (3) of subparagraph (A) of paragraph (10) of subdivision (a) of § 4052 of the Business and Professions Code.
(B) Furnishing naloxone hydrochloride, as authorized in § 4052.01 of the Business and Professions Code.
(C) Furnishing self-administered hormonal contraception, as authorized in subdivision (a) of § 4052.3 of the Business and Professions Code.
(D) Initiating and administering immunizations, as authorized in § 4052.8 of the Business and Professions Code.
(E) Providing tobacco cessation counseling and furnishing nicotine replacement therapy, as authorized in § 4052.9 of the Business and Professions Code.
(F) Initiating and furnishing preexposure prophylaxis, as authorized in § 4052.02 of the Business and Professions Code.
(G) Initiating and furnishing postexposure prophylaxis, as authorized in § 4052.03 of the Business and Professions Code.
(H) Providing MTM pharmacist services in conjunction with the dispensing of qualified specialty drugs, as described in Section 14132.969.
(2) Covered pharmacist services shall be subject to department protocols and utilization controls.
(c) A pharmacist shall be enrolled as an ordering, referring, and prescribing provider under the Medi-Cal program prior to rendering a pharmacist service that is submitted by a Medi-Cal pharmacy provider for reimbursement pursuant to this section.
(d) (1) The director shall seek any necessary federal approvals to implement this section. This section shall not be implemented until the necessary federal approvals are obtained and shall be implemented only to the extent that federal financial participation is available.
(2) This section neither restricts nor prohibits any services currently provided by pharmacists as authorized by law, including, but not limited to, this chapter, or the Medicaid state plan.
(e) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, and any applicable federal waivers and state plan amendments, by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions, without taking regulatory action. By July 1, 2021, the department shall adopt regulations in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. Commencing July 1, 2017, the department shall provide a status report to the Legislature on a semiannual basis, in compliance with § 9795 of the Government Code, until regulations have been adopted.
(Amended by Stats. 2024, Ch. 1, Sec. 4. (SB 339) Effective February 6, 2024.)