CA AB2100

Establishes the Independent Prescription Drug Medical Review System (IPDMRS) effective January 1, 2021, to review denials, modifications, or delays of outpatient prescription drugs based on medical necessity determinations by the Department of Health Care Services or its contractors.

Allows Medi-Cal beneficiaries to apply for independent review within 6 months of receiving notice of an adverse drug coverage decision at no cost, with reviews to be completed within 30 days by contracted independent medical review organizations.

Requires the department to maintain a searchable public database of all director decisions on drug coverage reviews with beneficiary demographics, diagnosis, drug details, and determination outcomes while protecting individual privacy.

Permits beneficiaries to continue using drugs covered by their prior managed care plan for a minimum of 180 days after transitioning to department-administered fee-for-service pharmacy benefits to ensure continuity of care.

Authorizes disease management or specialty drug access payments to pharmacies as necessary to ensure beneficiary access, and requires reporting of detailed pharmacy benefits data including actively billing pharmacies, drug expenditures, and treatment authorization requests in Medi-Cal budget assumptions.