SECTIONS 4425-4426 - California Statutes

BUSINESS AND PROFESSIONS CODE

SECTION 4425-4426

4425. (a) As a condition for the participation of a pharmacy in the
Medi-Cal program pursuant to Chapter 7 (commencing with Section
14000) of Division 9 of the Welfare and Institutions Code, the
pharmacy, upon presentation of a valid prescription for the patient
and the patient's Medicare card, shall charge Medicare beneficiaries
a price that does not exceed the Medi-Cal reimbursement rate for
prescription medicines, and an amount, as set by the State Department
of Health Care Services to cover electronic transmission charges.
However, Medicare beneficiaries shall not be allowed to use the
Medi-Cal reimbursement rate for over-the-counter medications or
compounded prescriptions.
(b) The State Department of Health Care Services shall provide a
mechanism to calculate and transmit the price to the pharmacy, but
shall not apply the Medi-Cal drug utilization review process for
purposes of this section.
(c) The State Department of Health Care Services shall monitor
pharmacy participation with the requirements of subdivision (a).
(d) The State Department of Health Care Services shall conduct an
outreach program to inform Medicare beneficiaries of their right to
participate in the program described in subdivision (a), including,
but not limited to, the following:
(1) Including on its Internet Web site the Medi-Cal reimbursement
rate for, at minimum, 200 of the most commonly prescribed medicines
and updating this information monthly.
(2) Providing a sign to participating pharmacies that the
pharmacies shall prominently display at the point of service and at
the point of sale, reminding the Medicare beneficiaries to ask that
the charge for their prescription be the same amount as the Medi-Cal
reimbursement rate and providing the department's telephone number,
e-mail address, and Internet Web site address to access information
about the program.
(e) If prescription drugs are added to the scope of benefits
available under the federal Medicare program, the Senate Office of
Research shall report that fact to the appropriate committees of the
Legislature. It is the intent of the Legislature to evaluate the need
to continue the implementation of this article under those
circumstances.
(f) This section shall not apply to a prescription that is covered
by insurance.

4426. The State Department of Health Care Services shall conduct a
study of the adequacy of Medi-Cal pharmacy reimbursement rates
including the cost of providing prescription drugs and services.