Medi-Cal: benefits: clinic costs for drugs and supplies.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law provides for a department-administered uniform schedule of health care benefits. Existing law sets the cost that specified clinics bill the Medi-Cal program and the Family PACT Waiver Program for drugs and supplies at an aggregate amount equivalent to the sum of the actual acquisition cost of a drug or supply plus a clinic dispensing fee not to exceed $12 per billing unit, as specified. Existing law sets the cost for a take-home drug that is dispensed for use by the patient within a specific timeframe of 5 or less days from the date medically indicated at the actual acquisition cost for that drug plus a clinic dispensing fee, not to exceed $17 per prescription. Existing law sets the reimbursement at the lesser of the amount billed or the Medi-Cal reimbursement rate and caps reimbursement at the net cost of these drugs or supplies when provided by retail pharmacies under the Medi-Cal program. This bill would remove the cap on the dispensing fees. The bill would require the clinic dispensing fee to be the difference between the actual acquisition cost of a drug or supply, to be calculated not less than annually, and the Medi-Cal reimbursement rate. The bill would also remove the cap on reimbursement that is based on the cost of drugs or supplies provided by retail pharmacies.