NYCU September 2, 2025 September 3, 2025 Advocacy, Cancer, CMA, Infectious Disease, MAHA, Medicaid, Medi-Cal, Member Social, Physician Workforce, Practice Management, Public Health, Regulations, SDCMS, Trump Administration, Vaccines 0 TUESDAY, SEPTEMBER 2, 2025 PHYSICIANS: The California Department of Health Care Services (DHCS) has released a notice of upcoming changes to Medi–Cal Rx as part of the 2025–26 state budget. The new rules will be phased in over the coming months, beginning with an update to the coordination of benefits (COB) claims process for Medicare members on November 1, 2025. Effective November 1, DHCS will adjust how pharmacy claims involving both Medi–Cal and Medicare (known as dual eligible) are submitted and adjudicated to streamline processing. Under the updated rules, pharmacies must submit COB claims with specific NCPDP field codes to ensure Medi–Cal Rx receives the correct payment status and addresses eligibility and payer accuracy. Additional changes effective January 1, 2026 include: COVID–19 Tests Over–the–counter COVID–19 antigen tests will require prior authorization (PA) for all Medi–Cal members. Weight Loss Drugs Medications used solely for weight loss or related indications will be removed from Medi–Cal Rx coverage, with patients likely having to pay out of pocket. Revisions to OTC coverage for Adults (21+) Reimbursement policies will change for certain OTC products, including prenatal vitamins, multivitamin combinations, single–ingredient vitamins, first– and second–generation antihistamines, and dry eye treatments. Continuation of Care Exceptions Removed Claims receiving coverage under previous continuation of care exceptions (e.g., for drugs listed on the Medi–Cal Rx Contract Drugs List) will no longer be accepted. Therapeutic Alternatives Required Use of certain non–covered drugs will now require prescribing therapeutically equivalent alternatives listed in the Medi–Cal Rx Contract Drugs List before reimbursement is possible. DHCS frames these changes as necessary to “reduce pharmacy spending, improve program integrity, and ensure continued, equitable access.” California Medical Association (CMA) will closely monitor the rollout of these updates to ensure they don’t inadvertently hinder patient access. For more information, practitioners can contact the Medi–Cal Rx Customer Service Center at (800) 977-2273 (available 24/7) or by emailing MediCalRxEducationOutreach@primetherapeutics.com. CALIFORNIA’S LARGEST FAMILY MEDICINE CONFERENCE IS HAPPENING HERE IN SAN DIEGO THIS WEEKEND On September 5th to 7th, the California Academy of Family Physicians (CAFP), the CAFP Foundation and the San Diego Academy of Family Physicians (SDAFP), are collaborating together to bring California’s largest family medicine conference, ‘Family Medicine POP! — Prism of Practice,’ to San Diego at Paradise Point Resort & Spa. The event is a convergence of the Clinical Forum (CAFP’s continuing education conference) and the Summit (the Foundation's professional development event for students and residents). CME credit is available. For more information and to register, CLICK HERE. DON’T MISS THE NEXT ‘PHYSICIAN SOCIAL & MIXER’ ON OCTOBER 10TH AT UCSD IDA & CECIL GREEN FACULTY CLUB You don’t want to miss our Fall Mixer on October 10th, from 5:30–8:00pm at the UC San Diego Ida & Cecil Green Faculty Club. There is already a large number of RSVPs but we want to see you there too! Come mingle, socialize and network with your fellow San Diego County physicians — SDCMS members and non–members are welcome and encouraged to attend. Complimentary light appetizers and hosted wine and craft beer will be provided. This event is open EXCLUSIVELY to physicians and their guests and space is limited, so reservations are required. You can REGISTER HERE. Contact Jen Ohmstede with any questions about the event at JOhmstede@SDCMS.org. As always, let me know if you have any questions! Paul Hegyi, CEO WHAT TO KNOW … What New Limits on Student Borrowing Mean for San Diego Doctors, Patients and Care CLICK HERE Newsom Promised Real Progress on CARE Court. Here’s What the Numbers Show CLICK HERE CVS and Walgreens Limit Access to COVID Vaccines as Required by Some State Guidelines CLICK HERE Typhus Outbreaks are Spiking in Southern California, Health Department Reports CLICK HERE Reduced Screening May Have Led to Rise in Advanced Prostate Cancer Diagnosis CLICK HERE RFK, Jr is Forcing Doctors to Make a Tough Choice CLICK HERE Trump Says CDC is Being ‘Ripped Apart’ Over COVID Products, Calls for Drugmakers to Prove Their Benefits CLICK HERE Former CDC Directors Say RFK, Jr is Endangering Americans’ Health CLICK HERE Feds Expand Probe into PBMs, Including Optum Rx CLICK HERE WHAT TO DO … SEP 5-7, 2025: 9am daily, Paradise Point Resort & Spa, San Diego, CA, sponsored by CAFP, CAFP Foundation and SDAFP, ‘Family Medicine POP! — Prism of Practice’. We recognize that the most unexpected connections and discoveries happen when diverse people come together to discuss diverse topics. So we’ve reimagined our annual events as a convergence of the Clinical Forum (CAFP's continuing education conference) and the Summit (the Foundation’s professional development event for students & residents). Plus in 2025 & 2026, CAFP and their foundation are collaborating with SDAFP to bring POP to beautiful San Diego! CME Credit available CLICK HERE SEP 9, 2025: 12-1pm, FREE Webinar for Members, Non–Members, NPs, and PAs, sponsored by CMA and CDPH, ‘Virtual Grand Rounds: Provider Consultation Programs for Supporting Youth & Maternal Mental Health’. While PCPs and clinicians of all specialties screen for mental health conditions such as anxiety and depression, many often lack training or skills to fully assess and treat these patients. Many patients with diagnosed mental health conditions are unable to promptly access behavioral health care too. Learn how Cal–MAP and LA PROMISE can provide clinicians real–time consultation with behavioral health physicians to help ensure their patients receive timely access to mental health care. Plus Erica Pan, MD, MPH, CA State Public Health Officer & Director of CDPH will update us on emerging infectious diseases in CA. CME credit available CLICK HERE SEP 16, 2025: 12:15-1:15pm, FREE Webinar for Members and Non–Members, sponsored by CMA, ‘Navigating the MultiPlan Litigation — What Physician Practices and Facilities Need to Know’. A sweeping federal antitrust lawsuit is moving forward against MultiPlan, Inc. and several major insurers including Aetna, Cigna, UnitedHealth and Blue Cross Blue Shield, alleging a price–fixing conspiracy that artificially suppressed out–of–network payment rates and cost providers billions of dollars. Following a key court ruling in June the case is headed into discovery, with potential damages tripled under federal law for successful claims. Matt Lavin, AGG Healthcare Litigation partner and member of the Executive Committee for direct–action plaintiffs will walk through the litigation’s origins, key legal developments and strategies for affected providers to consider, plus why now is a critical time to evaluate participation in the case to protect your rights and support industry reform. An open and confidential discussion will be encouraged during Q&A CLICK HERE SEP 18, 2025: 12:15-1:15pm, FREE Webinar for Members and Non–Members, sponsored by CMA and The Doctors Company, ‘Managing Adverse Events in the Office Practice’. Managing adverse patient safety events and unexpected health care outcomes in a medical office setting can be challenging due to the uniqueness of the situation, or lack of standard processes, resources, or trained staff. Learn about the most frequent types of claims and risk issues arising in outpatient care. This session provides a framework for responding to an adverse patient safety event or unexpected health care outcome in an office practice, including transparent communication and disclosure to the patient and their family, documentation of the event, and creating a culture of safety to learn from these unexpected events CLICK HERE SEP 23, 2025: 12:15-1:15pm, FREE Webinar for Members and Non–Members, sponsored by CMA, ‘Medicare Revalidations and Reporting Changes — Staying Compliant & Informed’. Kelsey Slettebak and Julie Schroeder of Noridian Healthcare Solutions will provide a comprehensive overview of the Medicare provider enrollment revalidation process. Gain a clear understanding of enrollment compliance, the revalidation process, reporting changes to an enrollment record and best practices for compliance and continuity CLICK HERE SEP 25, 2025: 12:15-1:15pm, FREE Webinar for Members and Non–Members, sponsored by CMA, ‘Safeguarding Medicare Enrollment — Preventing Deactivation, EFT Errors & Ownership Reporting Problems’. Medicare enrollment can be jeopardized by internal vulnerabilities often unnoticed until billing disruptions occur. Specifically in two critical risk areas, deactivation reasons and electronic funds transfer (EFT) documentation mismatches. Dan Schmitt and Julie Schroeder of Noridian Healthcare Solutions explore strategies for distributing access, maintaining continuity and preparing for transitions. Plus how discrepancies between practice names, IRS documentation and NPPES records can delay or block EFTs, even when updated documents like the 147C letter are submitted. Learn how to strengthen internal processes, align documentation and ensure uninterrupted operations with real–world examples and actionable guidance CLICK HERE OCT 10, 2025: 5:30–8:00pm, UC San Diego Ida & Cecil Green Faculty Club, 9500 Gilman Dr, La Jolla, ‘SDCMS Physician Social & Mixer’. Please note this event is open exclusively to physicians and their guests and space is limited so rsvps are required. SDCMS members and non–members are welcome and encouraged to attend. Complimentary light appetizers and hosted wine and craft beer will be provided CLICK HERE OCT 25, 2025: 8am, Tecolote Shores South Mission Bay, sponsored by Head for the Cure Foundation, ‘2nd Annual Head for the Cure 5K Run/Walk San Diego’. To raise awareness and funds for brain tumor research. Join or contribute to the effort by visiting the Team Dave! UCSD page created in honor of the late Dr. David Bazzo, former SDCMS President. Please support this worthwhile cause in Dr. Bazzo’s memory. For full details about the event CLICK HERE NOV 18, 2025: 6-7pm, FREE Webinar for Members and Non–Members, sponsored by TDC and SDCMS, ‘Understanding the Anatomy of a Lawsuit’. This webinar outlines and discusses the course that a medical malpractice lawsuit takes when filed against a physician in California. Walk through the physician’s receipt of a Notice of Intent to Sue and explore the litigation process, looking at what elements a Plaintiff must prove in order to prevail and how a defense would be built for the Defendant physician. We’ll also provide several proactive steps physicians can take in their own practice to be prepared if ever involved in a suit. CME credit available CLICK HERE HAT TO READ, LISTEN & WATCH … Podcast ‘What the Health?’ Happy 60th, Medicare and Medicaid! LISTEN HERE Alzheimer’s Project Clinical Roundtable Free On–Demand CME Webinar Series on Dementia WATCH HERE Champions for Health & TDC’s Free On–Demand CME Webinar Series ‘Innovations and Smart Approaches in Safe Prescibing’ to Help Fulfill DEA Training Requirements (Modules 1–5) WATCH HERE SDCMS Video Archive: View our FREE digital catalog of videos & webinars WATCH HERE SDCMS Webinar: Are You Aware and Prepared for New California Laws? WATCH HERE SDCMS Webinar: Managing the Noncompliant and Nonadherent Patient WATCH HERE SDCMS Webinar: Physician Financial Wellness (Part 1) WATCH HERE SDCMS Webinar: Physician Financial Wellness (Part 2) WATCH HERE SDCMS Webinar: Will Your Documentation Defend You? WATCH HERE Please Consider Supporting Our Advertisers … Thank You! This Email Was Sent to [[FIRSTNAME]] [[LASTNAME]] at [[EMAIL]] From the San Diego County Medical Society (SDCMS) Comments are closed.