AB 2565 California Assembly · 2025-2026 Regular Session

Medi-Cal: pharmacist services: reporting.

Summary

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services through fee-for-service (FFS) or managed care delivery systems. The Medi-Cal program is in part governed by, and funded pursuant to, federal Medicaid program provisions. Under existing law, pharmacist services are a benefit under the Medi-Cal program, subject to federal approval, as specified. Existing law authorizes the department to provide and administer Medi-Cal pharmacy services under a single statewide FFS delivery system, commonly known as the Medi-Cal Rx program. The department has implemented a transition of Medi-Cal pharmacy services, through Medi-Cal Rx, from managed care to FFS as a result of a 2019 executive order by the Governor. This bill would require the department to issue guidance clarifying Medi-Cal managed care plan obligations to cover pharmacist services, as specified. The bill would require the department to update its model evidence of coverage to explicitly include coverage of pharmacist services. The bill would also require the department to take appropriate corrective action for failure to comply with existing provisions of law relating to Medi-Cal coverage of pharmacist services or the issued guidance. The bill would authorize the department to implement, interpret, or make specific these provisions by means of all-plan letters, plan letters, or other similar instructions, without taking any further regulatory action.

Issues: ✓ Healthcare

Bill status passed both 4 of 5 stages cleared

Introduction

Feb 2026

Committee Review

Aug 2026

Assembly Passage

May 2026

Senate Passage

Aug 2026

Governor

Introduced Feb 20, 2026 Last action Aug 27, 2026

Maddy AI version diff · 4 comparisons

What changed between versions

08/24/26 - Enrolled → AB2565 · 1 edit

MINOR

No substantive policy changes were made between these two versions. The difference is purely presentational: the first version is a traditional printed legislative document with clerk signatures, page numbers, and chapter placeholders, while the second is a web page rendering of the same enrolled bill from the California Legislature website, complete with navigation menus and search interfaces.

TECHNICAL

The document format changed from a traditional printed legislative document (with page numbers, clerk signatures, and chapter number placeholders) to a web-based presentation including site navigation, search tools, and status metadata. The actual statutory text of Section 14132.967 and the legislative counsel's digest are identical in both versions.

04/23/26 - Amended Assembly → 08/24/26 - Enrolled · 4 edits · Aug 24, 2026

MODERATE

The enrolled version of AB 2565 removed the entire annual reporting requirement that had been in the amended assembly version. The bill originally required Medi-Cal managed care plans to submit annual reports on pharmacist services, with the department compiling a consolidated report to the Legislature by March 1 each year (initial deadline March 1, 2028). The enrolled version retains only the provisions requiring the department to issue guidance clarifying managed care plan obligations to cover pharmacist services, update its model evidence of coverage, and take corrective action for noncompliance.

Scope change

The bill's scope was significantly narrowed. It no longer creates a legislative transparency and accountability mechanism through annual reporting to the Legislature. The enrolled version focuses exclusively on administrative guidance issuance and enforcement authority regarding pharmacist services coverage in managed care plans.

REQUIREMENT

Removed the requirement for each Medi-Cal managed care plan to submit an annual report to the department containing information about pharmacist services within managed care jurisdiction.

TIMELINE

Removed the requirement for the department to submit an annual consolidated report to the appropriate policy and fiscal committees of the Legislature by March 1 each year, with an initial deadline of March 1, 2028.

SCOPE

Removed detailed reporting categories including implementation and compliance status, access disparities by county/region/demographics, claims payment and processing data (denial reasons, reimbursement rates, processing times), oversight and enforcement methods, provider complaint tracking, and fiscal/public health impact estimates including forgone cost savings.

ENFORCEMENT

Removed the specific corrective action provision tied to reporting noncompliance, which referenced Section 14197.7 sanctions for a pattern of noncompliance with reporting requirements.

03/19/26 - Amended Assembly → 04/23/26 - Amended Assembly · 7 edits · Apr 23, 2026

MODERATE

AB 2565 was substantially expanded to add new requirements for the Department of Health Care Services to issue binding guidance clarifying managed care plan obligations to cover pharmacist services, update its model evidence of coverage, and take corrective action against noncompliant plans or their delegated entities. The bill also dropped a previously included technical amendment to the Medi-Cal Act naming provision (Section 14000.4). These changes shift the bill from a primarily reporting-and-oversight measure to one that actively mandates how the department must enforce pharmacist services coverage through guidance and sanctions.

Scope change

The bill's scope expanded from a reporting and oversight framework to include active enforcement mechanisms. It now requires the department to proactively issue guidance, update model documents, and take corrective action against noncompliant managed care plans and their delegated entities (IPAs, subcontractors), rather than merely collecting and reporting data about pharmacist services coverage.

REQUIREMENT

New requirement for the department to issue guidance (including all-plan letters) clarifying managed care plan obligations to cover pharmacist services under Section 14132.968 and applicable state plan amendments.

The issued guidance must include minimum elements: coverage requirements consistent with law, expectations for timely reimbursement, accountability requirements at the delegated entity level (IPAs and subcontractors), and requirements that pharmacist services be clearly reflected in provider manuals, billing guidance, and claims processing systems.

The department is now required to update its model evidence of coverage to explicitly include coverage of pharmacist services described in Section 14132.968.

ENFORCEMENT

If the department determines a managed care plan or its delegated entity has failed to comply with Section 14132.968, state plan amendments, or departmental guidance, it must take corrective action including enforcement actions and sanctions.

TECHNICAL

The department is authorized to implement, interpret, or make specific the new provisions via all-plan letters, plan letters, or similar instructions without taking further regulatory action, bypassing the normal rulemaking process under Government Code Chapter 3.5.

The bill no longer amends Section 14000.4 of the Welfare and Institutions Code to name the Medi-Cal Act. This was a technical, nonsubstantive change that has been dropped from the bill.

FISCAL

The fiscal committee vote changed from 'no' to 'yes,' indicating the bill now carries a fiscal impact that requires fiscal committee review.

02/20/26 - Introduced → 03/19/26 - Amended Assembly · 7 edits · Mar 19, 2026

MODERATE

AB 2565 was dramatically expanded from a simple technical correction of the Medi-Cal Act's name into a comprehensive reporting and enforcement framework for pharmacist services in Medi-Cal managed care plans. The amended bill adds an entirely new section (14132.967) requiring annual reporting by managed care plans, a consolidated legislative report with detailed data on access, claims, compliance, and fiscal impact, and mandatory corrective action for noncompliant plans. This matters because it creates transparency and accountability around pharmacist services that are delivered through managed care rather than the state-run Medi-Cal Rx fee-for-service program.

Scope change

The bill's scope expanded dramatically from a purely technical correction (fixing duplicate words in the Medi-Cal Act name) to a substantive policy measure creating new reporting obligations, data transparency requirements, and enforcement mechanisms for pharmacist services in Medi-Cal managed care plans.

SCOPE

Added new Section 14132.967 to the Welfare and Institutions Code, expanding the bill from a one-line technical fix into a full reporting and enforcement regime for pharmacist services in Medi-Cal managed care plans.

REQUIREMENT

Requires each Medi-Cal managed care plan to submit an annual report to the department on pharmacist services within their jurisdiction that are not covered by the fee-for-service Medi-Cal Rx program.

Requires the department to compile a consolidated annual report to the Legislature's policy and fiscal committees by March 1 each year, with an initial deadline of March 1, 2028.

DEFINITION

Specifies that the consolidated report must include data on: implementation and compliance (including State Plan Amendments 18-0039, 19-0017, and 20-0036), access to pharmacist services with disaggregated data by geography and demographics, claims payment and processing details (denial reasons, reimbursement rates, processing times), oversight and enforcement actions, and fiscal and public health impact of underutilization.

ENFORCEMENT

Requires the department to take corrective action, including enforcement action and sanctions under Section 14197.7, if a managed care plan shows a pattern of noncompliance with pharmacist services provisions.

TECHNICAL

Allows the department to implement the new section via all-county letters, plan letters, or similar instructions without going through formal regulatory rulemaking, bypassing Chapter 3.5 of the Government Code.

FISCAL

The fiscal committee vote changed from 'no' to 'yes,' indicating the bill now carries a fiscal impact that requires legislative fiscal approval.

Floor votes · Senate Aug 20, 2026 · Assembly May 14, 2026

How they voted

39–0

Passed · 1 other

Total votes 40

Aug 20, 2026

D Democratic30

29 Yea 1

96% Yea

R Republican10

10 Yea

100% Yea

Vote distribution

All Yea All Nay Mixed No data

Full legislative history

Actions timeline

Total actions

Key actions

Committee

Amendments

Aug 20, 2026

Lower · Passed

In Assembly. Ordered to Engrossing and Enrolling.

lower

Aug 20, 2026

Upper · Passed

Read third time. Passed. Ordered to the Assembly. (Ayes 39. Noes 0.).

upper

Aug 13, 2026

Upper · Passed

From committee: Do pass. (Ayes 7. Noes 0.) (August 13).

upper

Jun 15, 2026

Committee

In committee: Referred to APPR. suspense file.

upper

Jun 4, 2026

Upper · Passed

From committee: Do pass and re-refer to Com. on APPR. with recommendation: To Consent Calendar. (Ayes 9. Noes 0.) (June 3). Re-referred to Com. on APPR.

upper

May 27, 2026

Committee

Referred to Com. on HEALTH.

upper

May 14, 2026

Lower · Passed

Read third time. Passed. Ordered to the Senate. (Ayes 77. Noes 0. Page 5056.)

lower

May 6, 2026

Lower · Passed

From committee: Do pass. To Consent Calendar. (Ayes 14. Noes 0.) (May 6).

lower

Apr 27, 2026

Committee

Re-referred to Com. on APPR.

lower

Apr 23, 2026

Lower · Passed

Read second time and amended.

lower

Apr 22, 2026

Introduced

From committee: Amend, and do pass as amended and re-refer to Com. on APPR. with recommendation: To Consent Calendar. (Ayes 16. Noes 0.) (April 21).

lower

Mar 23, 2026

Committee

Re-referred to Com. on HEALTH.

lower

Mar 19, 2026

Introduced

From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.

lower

Mar 19, 2026

Committee

Referred to Com. on HEALTH.

lower

Feb 21, 2026

Lower · Passed

From printer. May be heard in committee March 23.

lower

1 primary · 0 co-sponsors