Pharmacy FFS Reimbursement Changes for Covered Outpatient Drugs
As outlined in California's State Plan Amendment 17-002, DHCS is implementing a new FFS reimbursement methodology for covered outpatient drugs. Barring unforeseen delay, DHCS anticipates FFS pharmacy providers will see the new reimbursement methodology reflected in their claims with dates of service starting February 23, 2019. Because the policy effective date mandated by CMS is April 1, 2017, DHCS intends to make retroactive adjustments for all claims with dates of service between April 1, 2017, and the implementation date. DHCS will engage stakeholders in the upcoming months regarding how these claims adjustments will be rolled out. Additional information is available on the DHCS website.
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