Know your Pharmacy Benefits

Pharmacy Benefit: Medication you receive from a pharmacy

Beginning January 1, 2022, CenCal Health’s Pharmacy benefit called Medi-Cal Rx is administered through the Department of Healthcare Services (DHCS) and its vendor, Magellan Medicaid Administration. CenCal Health will no longer manage the pharmacy benefit part of your Medi-Cal benefit.

To get your medicine, 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.

At medi-calrx.dhcs.ca.gov, you can find more information about your pharmacy benefit. You can view the most up-to-date Medi-Cal Rx formulary and see if your medication is in it. You can see if your medication needs prior authorization or step therapy. You can find important forms and search for a pharmacy. There is also a list of commonly asked questions.

Questions regarding Rx Coverage, formulary, authorization, please contact Medi-Cal Rx Customer Service Center 1-800-977-2273.

When to call CenCal Health for Medi-Cal Rx questions:

If you have contacted Medi-Cal Rx Customer Service regarding a question about your prescription or prior authorization and have not received a response from Medi-Cal Rx, CenCal Health is here to assist you. Contact 1-877-814-1861.

Physician-Administered-Drug (PAD) Medical Pharmacy Benefit: Medication injected or infused at your doctor’s office or healthcare facility.

CenCal Health covers the PAD-Medical Pharmacy Benefit for you.  These medications are given to you by a healthcare provider and the healthcare provider bills CenCal Health on a medical claim for the service.  If the PAD requested by your doctor requires an authorization, you can view the authorization required medication list here. Coverage criteria is available upon request.

If you have any questions regarding the CenCal Health Physician-Administered-Drug Benefit, CenCal Health is here to assist you. Contact 1-877-814-1861.