SECTIONS 14185 - California Statutes

WELFARE AND INSTITUTIONS CODE

SECTION 14185

14185. (a) A managed care plan, as defined in accordance with
subdivision (a) of Section 14093.05, that has prescription drugs as
one of its benefits and that enters into a contract with the
department pursuant to this chapter or Chapter 8 (commencing with
Section 14200), shall ensure the timely and efficient processing of
authorization requests for drugs, when prescribed for plan enrollees,
that are covered under the terms of the plan's contract with the
department and require prior authorization from the plan, by
providing both of the following:
(1) A response within 24 hours or one business day to a request
for prior authorization made by telephone or other telecommunication
device.
(2) The dispensing of at least a 72-hour supply of a covered
outpatient drug in an emergency situation.
(b) A managed care plan, as defined in accordance with subdivision
(a) of Section 14093.05, that has prescription drugs as one of its
benefits and that enters into a contract with the department pursuant
to this chapter or Chapter 8 (commencing with Section 14200), shall
permit a Medi-Cal beneficiary enrolled in the plan to continue use of
a single-source drug which is part of a prescribed therapy in effect
for the beneficiary immediately prior to the date of enrollment,
whether or not the drug is covered by the plan, until the prescribed
therapy is no longer prescribed by the contracting physician.
(c) This section shall not alter or affect the terms of a contract
between the department and a managed care plan regarding the
responsibilities of the plan to cover prescription drugs prescribed
by a physician other than the treating or attending physician of the
plan.