Pharmacies: Medi-Cal program participation.

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 requires reimbursement to Medi-Cal pharmacy providers for drugs, as prescribed. As a condition for the participation of a pharmacy in the Medi-Cal program, and subject to specified exceptions, existing law requires the pharmacy, upon presentation of a valid prescription for a patient and the patient's Medicare card, to charge Medicare beneficiaries a price that does not exceed the Medi-Cal reimbursement rate for prescription medicines and an amount, as set by the department, to cover electronic transmission charges. Existing law prohibits Medicare beneficiaries from being allowed to use the Medi-Cal reimbursement rate for over-the-counter medications or compound medications. Existing law provides that these provisions do not apply to a prescription that is covered by insurance. Existing law requires the department to conduct an outreach program to inform Medicare beneficiaries of their right to participate in this program. This bill would expand these provisions to also apply to any patient upon presentation of a valid prescription for the patient and evidence of residency in California. The bill would provide that for purposes of these provisions "covered by insurance" does not apply to a prescription for a specific medication prescribed for a patient that is not included on the drug formulary maintained by that patient's health care service plan or health insurer, and for which the patient is prepared to pay cash.