Non-Covered Prescriptions

Dear Advocate,

My father lives in a nursing home and recently developed a rash requiring the attention of a dermatologist who prescribed a medicated cream that is not covered by Medi-Cal. Am I correct in assuming that we must pay privately for the prescription?

Sincerely,
A concerned daughter in Fresno

Dear Daughter,

Yes, you do have to pay privately for a prescription not covered by Medi-Cal. However, the charges can be deducted from the share of cost before you pay the nursing home. Under the Johnson v. Rank judgment effective October 1, 1989, all Medi-Cal recipients must have the opportunity to use their Share of Cost to purchase medically necessary medical or remedial care, supplies and/or equipment not paid for by the Medi-Cal program and ordered by their physician. You need to get the prescription from the doctor, make a copy for the facility, fill the prescription at the pharmacy, bring the bill (and a copy of the prescription) to the facility and deduct the cost of the prescription from that month’s share of cost. Although you will have to pay initially for the prescription at the pharmacy, you can then deduct the amount paid out from your dad’s share of cost for that month.