Pharmacist Services
Provider Type
- Participating Physician Groups (PPG)
Pharmacists may bill for covered services that are within the pharmacist's scope of practice and follow certain conditions for members. Pharmacists must be reimbursed 85% of the Medi-Cal fee schedule for these services under the member’s medical benefit.
Participating physician groups (PPGs) must pay pharmacists for services that are within their professional scope. This applies to pharmacist services delivered in both in-network pharmacies and, if the member has this covered in their pharmacy benefit, out-of-network pharmacies.Pharmacists will only be reimbursed under the following conditions:
- Services performed are within the lawful scope of practice of the pharmacist.
- The member’s coverage provides reimbursement for identical services performed by other licensed health care providers.
PPGs are responsible for reimbursing duly licensed pharmacist delivered services under their Division of Financial Responsibility for the category of the service description.