All California Medi-Cal plans use the formulary or covered drug list made by the Department of Health Care Services (DHCS). Medi-Cal Rx handles the covered drug list for DHCS.
The state’s covered drugs list can be found by going to www.Medi-CalRx.dhcs.ca.gov.
You can check if your prescribed drug is covered by browsing the covered drug list online or the covered drug list document posted by the state. Covered drugs on the list have been chosen for their safety and efficacy. The state may have limits for coverage on certain prescribed drugs. Some drugs on the list may need a prior review request to be sent. These limits exist so members can use drugs in the most safe and effective way. Your doctor should order drugs from this list. If they choose to order drugs outside of the list, then a prior review request would also be needed. All prior review requests must be sent to Medi-Cal Rx for review. Medi-Cal members should not be asked to pay for any prescribed drugs. DHCS can also give a copy of the covered drug list in your preferred language, large print, audio, or other format.
You can also get to the member portal ( “Beneficiary Portal”) by going to www.Medi-CalRx.dhcs.ca.gov
You must also use pharmacies within the Medi-Cal Rx pharmacy network. To check if your pharmacy is within the network, visit www.Medi-CalRx.dhcs.ca.gov.
Always bring your Medi-Cal Benefits ID card and your HPSJ member ID card to the pharmacy. Below are samples of what your Medi-Cal Benefits ID card looks like.
If there are any questions about the covered drug list, drug limits, or pharmacy network, please call the Medi-Cal Rx Call Center Line at 1-800-977-2273 TTY/TDD 711, 24 hours a day, 7 days a week or visit www.Medi-CalRx.dhcs.ca.gov