There are many tools used by health plans, health insurers, and pharmacy benefit managers to help ensure patient safety, increase efficiency, and manage costs in the healthcare system. These are generally referred to as utilization management techniques. Learn more about some common tools in this overview.
A brief introduction to Medi-Cal Rx, the state program responsible for pharmacy benefits for Medi-Cal recipients. Learn about the history of the program, who it serves, and how it differs from commercial insurance.
This issue brief discusses the medical necessity determination process, which may involve multiple clinicians, for enrollees in health plans and health policies regulated by the Department of Managed Health Care (DMHC) or the California Department of Insurance (CDI).
Issue Brief
Health Insurance Coverage
Medical Necessity Determination Process for Covered Benefits
There are many tools used by health plans, health insurers, and pharmacy benefit managers to help ensure patient safety, increase efficiency, and manage costs in the healthcare system. These are generally referred to as utilization management techniques. Learn more about some common tools in this overview.
