Medi-Cal’s Pharmacy Benefits

Do I need to do anything different than I do today?

Most people will not need to do anything. DHCS will automatically transition from the existing administrator to Magellan on January 1, 2022.

Your health plan, if enrolled in a plan, doctors and pharmacies know about the change and know what to do.

There is no change in your Medi-Cal eligibility or benefits.

Starting January 1, 2022, bring your Medi-Cal Benefits Identification Card, the BIC, when you go to the pharmacy. The pharmacy will use your card to look up your information and give you your medications.

Will I have to change my medications?

Most people will not have any change in their medications. The list of medications that Medi-Cal Rx allows without a prior approval may be different than the list your health plan uses. If you are on a medication that needs a prior approval, your doctor or pharmacy will have to fill out a form and get approval when you renew your prescription. Your doctor might also talk to you about changing to a medication that is similar that doesn’t need prior approval. Your doctor and pharmacy will know about this change.

Will I have to find a new pharmacy?

You will probably be able to use the same pharmacy you do now starting January 1, 2022. But there may be pharmacies that are not enrolled with Medi-Cal Rx.

If you use a mail order pharmacy that is based outside of California, you may need to change to another one that is in the Medi-Cal Rx system.

If you need help finding a pharmacy near you starting January 1, 2022, use the Medi-Cal Rx Pharmacy Locator online at www.Medi-CalRx.dhcs.ca.gov or call Medi-Cal Rx Customer Service at 1-800-977-2273 twenty-four hours a day, seven days a week, or 711 for TTY Monday thru Friday, 8am to 5pm (Note: The website pharmacy locator will be available in December 2020).

If you need help finding a pharmacy for Medi-Cal Rx in advance of January 1, 2021, contact the Medi-Cal Member Help Line (1-800-541-5555, TTY 1-800-430-7077), Monday thru Friday, 8am to 5pm

What to do if you have Medicare and MediCal Coverage?

If you are eligible for both Medicare and Medi-Cal, the Medi-Cal Rx transition does not change your current Medicare Part D pharmacy coverage. Medi-Cal Rx may cover things Medicare does not, so you should talk to your doctor or pharmacy if you have questions.

You should take your health plan ID Card and Medi-Cal Benefits Identification Card, the BIC card, when you go to the pharmacy. The pharmacy will use the information on your cards to look up your information and give you your medications.

Is the CCS program impacted?

Yes, the CCS program is included in the transition to Medi-Cal Rx. The DHCS Pharmacy benefits service provider, Magellan, will manage your authorizations and pharmacy claims payment. Your provider and pharmacy will be trained and knowledgeable of the new program. We have implemented policies to eliminate or minimize impacts to CCS beneficiaries.

For additional information, contact your managed care plan; or, contact your county CCS Office.

Who can I contact for more information? (MCP Members)

If you receive your care from a health plan and have questions about your medication or other pharmacy services prior to January 1, 2022, please call your Managed Care Plan.

You can call the Medi-Cal Member Help Line (1-800-541-5555, TTY 1-800-430-7077), Monday thru Friday, 8am to 5pm.

You can also call the Medi-Cal Rx Customer Service Center line (1-800-977-2273 twenty-four hours a day, seven days a week or 711 for TTY, Monday thru Friday, 8am to 5pm).

Will the Drug Formulary, also known as Contracted Drug List (CDL), be different in Medi-Cal Rx?

Medi-Cal FFS covers all FDA approved drugs but uses a Contract Drugs List (CDL) to determine what drugs are subject to Prior Authorization.

The Medi-Cal Rx Contracted Drug List (CDL) gets updated monthly and is available in the current FFS Medi-Cal website.