SB 619, as introduced, Morrell. Medi-Cal.
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, including pharmacy services and drugs. Existing law requires pharmacy providers to submit their usual and customary charge when billing the Medi-Cal program for prescribed drugs.
This bill would make a technical, nonsubstantive change to that provision.
Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 14105.455 of the Welfare and Institutions
2Code is amended to read:
(a) Pharmacy providers shall submit their usual
4and customary charge when billing the Medi-Cal program for
5prescribed drugs.
6(b) “Usual and customary charge” means the lowerbegin insert of eitherend insert of
7the following:
P2 1(1) The lowest price reimbursed to the pharmacy by other
2third-party payers in California, excluding Medi-Cal managed care
3plans and Medicare Part D prescription drug plans.
4(2) The lowest price routinely offered to any segment of the
5general public.
6(c) Donations or
discounts provided to a charitable organization
7are not considered usual and customary charges.
8(d) Pharmacy providers shall keep and maintain records of their
9usual and customary charges for a period of three years from the
10date the service was rendered.
11(e) Payment to pharmacy providers shall be the lower of the
12pharmacy’s usual and customary charge or the reimbursement rate
13pursuant to subdivision (b) of Section 14105.45.
14(f) Notwithstanding Chapter 3.5 (commencing with Section
1511340) of Part 1 of Division 3 of Title 2 of the Government Code,
16the department may implement, interpret, or make specific this
17section by means of a provider bulletin or notice, policy letter, or
18other similar instructions, without taking regulatory action.
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