Transitioning Medi-Cal Pharmacy Benefits from Managed Care to Medi-Cal RX
Customize your policy alerts
Sign up for all kernfamilyhealthcare policy alerts
Know when kernfamilyhealthcare releases new policies or updates existing guidance.
Monitor payer policy activity
This document notifies providers that, effective January 1, 2021, Medi-Cal pharmacy services are moving from managed care (Kern Health Systems) to the Fee‑For‑Service Medi‑Cal Rx program and explains which benefits and processes are affected and where to get information.
Effective January 1, 2021, DHCS is transitioning Medi‑Cal pharmacy services from the managed care delivery system to the Fee‑For‑Service Medi‑Cal Rx.
Kern Health Systems will no longer be responsible for Medi‑Cal covered outpatient drugs and identified medical supplies.
Coverage and Transition Criteria
Medi‑Cal Rx transition criteria
Post-transition coverage administration
Provider Responsibilities and Authorization Transfer
Authorization transfer to Medi‑Cal Rx (effective 1/1/2021)
Authorizations for pharmacy items that transition from Kern Health Systems to Medi‑Cal Rx will be handled by Medi‑Cal Rx starting January 1, 2021. Providers whose billing or authorization processes change will receive KHS contract amendments explaining required actions.
- Effective date: January 1, 2021
- Scope: outpatient pharmacy claims, authorizations, appeals, and customer service for transitioned items
- KHS will no longer be responsible for Medi‑Cal covered outpatient drugs and identified medical supplies
Key Definitions and Program Ownership
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.