Health plan social distancing measures — telehealth and pharmacy

The California Department of Managed Health Care Social Services (DMHC) encourages health plans to take measures regarding telehealth and pharmacy visits in response to COVID-19.

Health plans should expedite any pre-authorization or pre-certification requirements for contracted providers to cover care delivered by telehealth.  The plan should either expedite review or relax requirements to allow the plan to more quickly approve offering services via telehealth.  Plans should also waive applicable cost-sharing for telehealth, notwithstanding that cost-sharing might apply if the provider delivered the care in person.

Plans should allow at least a 90 day maintenance supply of drugs unless the enrollee’s provider indicates a shorter supply of the drug is appropriate for the enrollee.  Plans should suspend prescription drug refill limitations where the enrollee’s provider indicates a refill is appropriate.  Plans should waive delivery charges for home delivery of prescription medications.  (APL 20-007, March 12, 2020.)