We should delay Jan. 1 launch of Medi-Cal Rx drug program

Millions of low-income Californians are about to have their prescription drug benefit change on Jan. 1, 2021. Yet, you probably have not heard much about it.

On his first day in office, Gov. Newsom proposed several bold initiatives to contain the cost of prescription drug prices, including “Medi-Cal Rx,” a change in how the state administers the prescription drug benefit for the nearly 11 million Medi-Cal enrollees who get their coverage through a health plan.

The prescription drug benefit is the most frequently utilized benefit impacting the health status of millions of Californians.

For over 25 years, health plans have coordinated the care for the majority of Californians with Medi-Cal coverage – including doctors’ visits, hospital stays, labs, medical equipment and medicines. Under the concept of coordinated care, the idea is to have one entity responsible for delivering all of a Medi-Cal enrollee’s health care needs.

Under Medi-Cal Rx, responsibility for the Medi-Cal prescription drug benefit will be transferred to the state. This is an enormous undertaking, especially in the uncertainty of COVID and the looming flu season.

It means, for example, prescribers and pharmacists will have to adapt to a new system for prescribing medicines, the state will need to establish administrative services comparable to what plans offer today, and patients will have to learn who to contact for questions and appeals regarding prescription drug decisions. We will also need a timely system for keeping health plans looped in on patients’ prescription information since plans will still be responsible for covering and coordinating all other aspects of care.

Even in the best of times, enacting a change of this magnitude within the Medi-Cal program would be a significant undertaking.

For months, health care stakeholders have been working closely with the state to help it get ready for the implementation of Medi-Cal Rx by January 2021. The prescription drug benefit is the most frequently utilized benefit impacting the health status of millions of Californians. The stakes are high for real people under Medi-Cal Rx. 

As with so much of society, the best-laid plans have been sidelined by COVID-19.

The state, along with the entire medical community, rightly, had to devote nearly all its capacity to address the immediate needs created by the pandemic. Even in the best of times, enacting a change of this magnitude within the Medi-Cal program would be a significant undertaking. But we are not in the best of times and these critical planning efforts have competed with other pressing priorities.

There is an abundance of concern that unresolved issues and a lack of preparation could have real consequences for patients with serious, life-threatening health care needs. Beginning in October, Medi-Cal enrollees are scheduled to receive their first written notifications about the switch of their drug benefit to Medi-Cal Rx. Once these notices go out, program rollout will have begun and it is much harder to change course.

We applaud the governor’s goal of containing prescription drug costs and want to work collaboratively to ensure a smooth and successful launch of Medi-Cal Rx. But, as we brace for a looming flu season, as well as continuing to address COVID-19, we do not have the capacity to ensure Medi-Cal Rx is ready to meet the needs of all 11 million Medi-Cal enrollees by January.

Delaying Medi-Cal Rx allows California’s medical community to remain focused on our very real public health emergency and gives all parties the time to resolve outstanding issues and properly test systems so Medi-Cal beneficiaries do not experience unnecessary delays in getting their prescriptions filled. We urge the state to consider an immediate postponement of Medi-Cal Rx – before the first notices are mailed – in recognition of our state’s current circumstances.
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Editor’s Note: Brianna Lierman is the CEO of Local Health Plans of California,  a statewide trade association representing all 16 of the publicly managed, not-for-profit health plans providing comprehensive health care services for low-income Medi-Cal enrollees.