A prior-authorization change is easiest to manage before a prescription rejects at the pharmacy. Medi-Cal Rx notified affected members in fall 2025 and published a December 1 countdown explaining that selected continuing-care medications would move to a new approval requirement on January 1.
Quick Answer
Beginning January 1, 2026, selected chlorpromazine, fluphenazine, haloperidol, timolol, bimatoprost, and Adhansia XR products that had been covered as continuing-care exceptions will require an approved prior authorization showing medical necessity. If you use one of the affected products, compare the exact name, strength, and dosage form on your label with the Medi-Cal Rx list, contact your prescriber before the January refill, and ask who will handle any required authorization. Do not stop, reduce, stretch, or switch the medication on your own because of the coverage change.
What Changes With Medi-Cal Rx on January 1, 2026
Medi-Cal Rx’s December 1, 2025 update said that certain drugs and products currently paying as continuing-care exceptions would no longer be covered without an approved prior authorization demonstrating medical necessity.
The policy applies to all Medi-Cal members using the specified products. It does not mean every prescription with the same generic drug name is affected. The product, strength, and dosage form matter.
- Late October 2025
- Targeted letters were sent to identified members using affected products.
- December 1, 2025
- Medi-Cal Rx published its 30-day countdown reminder.
- January 1, 2026
- The new PA requirement begins for the listed products.
- What does not change
- Patients should not alter treatment because of a pharmacy-benefit rule.
Important Distinction
Which Medications Are on the January Prior-Authorization List?
Medi-Cal Rx named specific products rather than entire broad medication categories. Check the exact label before deciding that your prescription is affected.
- Antipsychotic injections
- Selected chlorpromazine, fluphenazine, haloperidol decanoate, and haloperidol lactate products.
- Eye medications
- Selected timolol, timolol maleate, and bimatoprost products.
- ADHD medication
- Specified Adhansia XR capsule strengths.
- Exact product matters
- Strength and dosage form determine whether the January list applies.
Check an affected medication
Chlorpromazine
Fluphenazine
Haloperidol
Timolol
Bimatoprost
Adhansia XR
If your medication is not on this list but a pharmacy claim says prior authorization is required, ask the pharmacy for the claim message. Other Medi-Cal Rx medications can have separate authorization or coverage rules.
Why Continuing the Medication Does Not Automatically Guarantee Approval
Medi-Cal Rx states that continuation of therapy by itself does not establish medical necessity for these products under the new policy. In other words, already taking a medication is not the only information the program may review.
For select noncovered drugs, Medi-Cal Rx also notes that a covered therapeutic alternative on the Contract Drugs List may need to be considered first. If the current medication remains clinically appropriate, the prescriber may need to submit information explaining why the requested product is medically necessary.
Prescriber Decision
Six Questions to Ask Before the January Refill
01. Does my exact medication, strength, and dosage form appear on the January list?
02. When will my current supply run out?
03. Does my prescriber need to submit a prior authorization before the refill?
04. Is a covered alternative being considered, and is it appropriate for me?
05. Who should I contact if the January pharmacy claim rejects?
06. What should I do if I receive a Notice of Action denying coverage?
Do Not Wait for the First Rejected Claim
Fireside Pharmacy can help identify refill timing, explain a pharmacy claim message, and tell you when prescriber information may be needed.
What if You Need the Medication Before the PA Is Finished?
Medi-Cal Rx tells members to speak with the pharmacist when a medication requires approval but is needed right away. In some situations, a member may qualify for an emergency fill of up to a 14-day supply.
An emergency fill is not the same as final PA approval. The pharmacist must determine whether the emergency-fill rules apply, and the prescriber may still need to complete the authorization process for continued coverage.
Do Not Ration Medication
What Patients Can Do Before the Next Refill
A short December review can prevent a January claim problem from becoming a medication gap.
01. Check the exact medication name, strength, and dosage form on the pharmacy label.
02. Count how much medication remains and note the next expected refill date.
03. Contact the prescriber early if the prescription appears on the affected list.
04. Ask who will submit the prior authorization if one is required.
05. Keep any Notice of Action and read the appeal instructions promptly.
06. Call Medi-Cal Rx at 1-800-977-2273 if you need help understanding the benefit decision.
Frequently Asked Questions
Which medications are affected by the January 1 continuing-care change?
Medi-Cal Rx lists specified chlorpromazine, fluphenazine, haloperidol decanoate, haloperidol lactate, timolol, timolol maleate, bimatoprost, and Adhansia XR products. The exact strength and dosage form matter.
If I have used the medication for a long time, will the PA automatically be approved?
No. Medi-Cal Rx states that continuation of therapy alone does not establish medical necessity. The authorization may need clinical information supporting continued use of the requested product.
Can my pharmacy submit all of the information for the PA?
The pharmacy can identify the claim issue and assist with prescription-processing questions, but clinical information often comes from the prescriber. Ask which office is responsible for the submission.
Can I get an emergency supply while the PA is pending?
Possibly. Medi-Cal Rx says members who need a medication right away should ask the pharmacist because an emergency fill of up to a 14-day supply may be available when the program’s emergency-fill rules are met.
What can I do if Medi-Cal Rx denies continued coverage?
A Notice of Action includes State Hearing rights. Medi-Cal Rx states that members generally have 90 days to request a hearing. For certain members already taking an affected drug who request a hearing within 10 days of a denial notice, continued coverage may be available while the hearing is pending, subject to the stated conditions.
Have a January Prescription Question?
Use the short form above to request a call about a refill, claim message, prior authorization, transfer, pickup, or delivery question.
