CaliforniaHealth plans would reimburse enrolled pharmacists for covered services
Health plans would reimburse enrolled pharmacists for certain covered services, while Medi-Cal payments for advanced practitioners and specialty drug support would depend on federal approval and available funding.
What it does
Plans and disability insurers would pay or reimburse enrolled pharmacists for covered services, including pharmacists at community health centers and rural clinics, when they cover similar care by other providers.
Medi-Cal would pay advanced pharmacist practitioners at least 85% of the physician-service rate, including for medication therapy management, if federal approval and funding are available.
With federal approval and funding, and a state appropriation, eligible clinic pharmacists and pharmacies could receive Medi-Cal payments for medication support tied to certain specialty drugs.
Argument forIf approvals and funding are in place, eligible clinic pharmacists could receive Medi-Cal payments for specialty drug support, giving patients another source of care.
Argument againstPlans might pay for more pharmacist services when they cover similar services by other providers, which could raise costs for plans and their customers.
More detail
Health care plans and disability insurers would pay or reimburse enrolled pharmacists for covered services. This applies to health care service plans and disability insurers that offer coverage for services within a licensed pharmacist’s scope. Pharmacists working at federally qualified health centers and rural health clinics are included. Medi-Cal managed care plans are excluded from the health plan rule. The service must be within the pharmacist’s lawful scope and the coverage must pay for similar services by other licensed providers. Out-of-network pharmacy services qualify only if the plan or insurer offers that benefit. A provider cannot be paid twice for the same service.
Medi-Cal would pay advanced pharmacist practitioners at least 85% of the physician-service fee schedule. The minimum rate applies to advanced pharmacist practitioner services under Medi-Cal, including medication therapy management services. The Medi-Cal changes cannot be implemented until necessary federal approvals are obtained and may be implemented only where federal funding is available.
The state would recognize advanced pharmacist practitioners at federally qualified health centers and rural clinics for Medi-Cal payment and set up a payment method for eligible specialty drug support. The payment method covers medication therapy management linked to specialty drug categories selected by the state. Eligible providers include contracted Medi-Cal pharmacies and advanced pharmacist practitioners. The state must obtain federal approval, and federal funding must be available. Clinic recognition also depends on a state budget appropriation. The payment method is subject to an annual appropriation. Only eligible advanced pharmacist practitioners or pharmacies with a state contract may receive these payments. The payment method would apply to services on or after July 1, 2021, or the effective date of necessary federal approval, whichever is later.
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Where it stands
- Introduced
- Passed Assembly
- Passed Senate
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Sep 27Vetoed by Governor Gavin Newsom.Latest
- Sep 4Enrolled and presented to the Governor at 4 p.m.To Governor
- Aug 27Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 78. Noes 0. Page 6678.).Major
- Vote recorded AB 2571 Flora Concurrence in Senate Amendments. Result: pass.Lower
- Aug 25In Assembly. Concurrence in Senate amendments pending.
- Vote recorded 3rd Reading AB2571 Flora By Ashby. Result: pass.Upper
- Aug 25Read third time. Passed. Ordered to the Assembly. (Ayes 39. Noes 0.).Passed Senate
- Aug 24Read second time. Ordered to third reading.Minor
- Aug 20Read third time and amended. Ordered to second reading.Major
- Aug 19Ordered to third reading.Minor
- Aug 19From special consent calendar.
- Aug 18Ordered to special consent calendar.
- Aug 13Read second time. Ordered to third reading.Minor
- Vote recorded Do pass. Result: pass.Upper
- Aug 13From committee: Do pass. (Ayes 7. Noes 0.) (August 13).Minor
- Jun 15In committee: Referred to APPR. suspense file.Minor
- Vote recorded Placed on suspense file. Result: pass.Upper
- Jun 8Read second time and amended. Re-referred to Com. on APPR.Major
- Jun 4From committee: Amend, and do pass as amended and re-refer to Com. on APPR. with recommendation: To Consent Calendar. (Ayes 9. Noes 0.) (June 3).Major
- Jun 3
- Vote recorded Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations] with the recommendation: To Consent Calendar. Result: pass.Upper
- May 20From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH.Major
- May 6Referred to Com. on HEALTH.Minor
- Apr 16In Senate. Read first time. To Com. on RLS. for assignment.Minor
- Vote recorded AB 2571 Flora Consent Calendar Second Day. Result: pass.Lower
- Apr 16Read third time. Passed. Ordered to the Senate. (Ayes 68. Noes 0. Page 4683.)Passed Assembly
- Apr 9Read second time. Ordered to Consent Calendar.Minor
- Apr 8From committee: Do pass. To Consent Calendar. (Ayes 14. Noes 0.) (April 8).Minor
- Vote recorded Do pass. To Consent Calendar. Result: pass.Lower
- Mar 25From committee: Do pass and re-refer to Com. on APPR. with recommendation: To Consent Calendar. (Ayes 16. Noes 0.) (March 24). Re-referred to Com. on APPR.Minor
- Mar 24
- Vote recorded Do pass and be re-referred to the Committee on [Appropriations] with recommendation: To Consent Calendar. Result: pass.Lower
- Mar 9Referred to Com. on HEALTH.Minor
- Feb 21From printer. May be heard in committee March 23.
- Feb 20Read first time. To print.Introduced
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