This morning CPhA learned that the following message was sent from the Dept. of Health Care Services to pharmacies participating in the Medi-Cal program:

Assembly Bill 97 (Chapter 3, Statutes of 2011) authorizes the Department of Health Care Services (DHCS) to reduce Medi-Cal payments to pharmacies for certain drugs, effective June 1, 2011. During the week of June 1, 2015 (this week) DHCS will send letters to pharmacies advising them of the department's intent to begin recouping funds no less than 60 days from the date of the letter for claims dating from June 1, 2011 to February 6, 2014. The recouped amounts will be subtracted from weekly payments for claims from DHCS to the pharmacies at a rate of approximately 5% of the pharmacy's weekly Medi-Cal check write until the accounts receivable for the recoupment is paid in full.  Pending CMS approval, the 10 percent reduction will not be retroactively applied to claims for drugs that the Department of Health Care Services (DHCS) initially identified as being exempt from the 10 percent reduction pursuant to State Plan Amendment 12-014.  As has been the DHCS commitment, the purpose of the letters is to provide advance notice of when the recoupment will begin.  These 60-day notices WILL NOT contain the total amount due for each pharmacy; that information will be provided just prior to the actual recoupment implementation.  

DHCS stated that questions regarding the recoupment should be directed to the Telephone Service Center at 1-800-541-5555.

CPhA has requested additional information from DHCS regarding this notice, and soon as more information is available, will provide it to our members in future Rx Alert messages.