CenCal Health is committed to providing consistent, compassionate, and local support to all CenCal Health providers and members.
CenCal Health’s Pharmacy Team is comprised of Pharmacist and Pharmacy Technician staff. Our Pharmacy Team is ready to assist our provider network and membership with pharmacy-related inquires and education.
Medi-Cal Rx: Medi-Cal Pharmacy Benefit
Effective January 1, 2022, CenCal Health’s Pharmacy benefit called Medi-Cal Rx is administered through DHCS and its vendor, Magellan Medicaid Administration. Magellan provides a comprehensive suite of administrative services as directed by DHCS, which includes claims management/adjudication, prior authorization, utilization management, and customer/support.
Medi-Cal Rx is responsible for administering the following when billed by a pharmacy on a pharmacy claim:
- Covered Outpatient Drugs, including Physician-Administered -Drugs (PADs)
- Medical Supplies
- Enteral Nutritional Products
Additional information regarding Medi-Cal Rx can be found in the “Medi-Cal Rx News” tab below and directly from the DHCS Medi-Cal Rx web site.
For additional assistance contact Medi-Cal Rx Customer Service at: (800) 977-2273
You may also want to visit the Medi-Cal Rx Communication page for any upcoming bulletins and news.
CenCal Health Pharmacy Services: Medical Pharmacy Management
CenCal Health and the Pharmacy Services Team will be responsible for a variety of activities including, but not limited to: oversight of clinical pharmacy adherence, Drug Utilization Review (DUR) and all utilization management associated with pharmacy services (Physician-Administered-Drug) billed on a medical and institutional claim. CenCal Health defines the utilization management of Physician-Administered-Drugs on the medical benefit as Medical Pharmacy Management.
Additional information and education resources for CenCal Health’s Medical Pharmacy Management Program can be found on our Medical Pharmacy Management page.
Medi-Cal Rx Reinstatement Plan
Key Reinstatement Dates
- January 20, 2023: Phase II, Wave 1 begins for new starts only
- February 24, 2023: Phase II, Wave 2 begins
- March 24, 2023-June 23, 2023: Series of Transition Lifts
Key Reinstatement Publications
Reinstatement Spotlight: weekly publication released every Friday by Medi-Cal Rx to provide essential information.
Medi-Cal Rx Spotlight Publications can be viewed by signing up for Medi-Cal Rx Subscription Service or by visiting Medi-Cal Rx Bulletins & News
Medi-Cal Rx Retirement of the Transition Policy Begins March 24, 2023
Medi-Cal Rx will initiate the first of a series of transition policy lifts for beneficiaries 22 years of age and older starting March 24, 2023. A transition lift is the retirement or phasing out of the transition policy for identified Standard Therapeutic Classes (STCs) that lifts the override of a Prior Authorization Requirement. Identified STCs will now require a Prior Authorization for members currently receiving a medication in the STCs impacted by the transition policy retirement. Providers should consider covered therapies that do not require a prior authorization or submit a prior authorization if a change in therapy is not appropriate.
30-Day Countdown – Phase III, Lift1:Retirement of the Transition Policy for Beneficiaries 22 Years of Age and Older(ca.gov)
April 21, 2023-Phase III, Lift 2
30-Day Countdown-Phase III, Lift 2: Retirement of the Transition Policy for Beneficiaries 22 Years of Age and Older
May 19,2023-Phase III, Lift 3
30-Day Countdown-Phase III, Lift 3: Retirement of the Transition Policy for Beneficiaries 22 Years of Age and Older
Additional information regarding this transition policy and a list of STCs included in this transition can be found on the Medi-Cal Rx Education and Outreach page by selecting Medi-Cal Rx Reinstatement.
For any provider inquiries regarding the Medi-Cal Rx Reimplementation Plan, call the CenCal Health Pharmacy Department at (805) 562-1080.
For questions regarding the reinstatement plan, please contact Medi-Cal Rx at (800) 977-2273. The CenCal Health Pharmacy Department can also assist with inquires at (805) 562-1080.
Medi-Cal Rx Resources and Contracted Drug List (CDL)
Medi-Cal Rx Searchable Drug Lookup & Contracted Drug List
Medi-Cal Rx Contract Drug List
Find a Pharmacy Search Tool
Medi-Cal Rx Support Services
The following document will provide the processing information for Medi-Cal Rx (i.e. BIN, PCN & Group) and additional payer information.
Medi-Cal Rx Support Services and Key Payer Sheet Details
Pharmacies requesting additional operational claims support please contact:
Medi-Cal Rx Customer Service Center at: (800) 977-2273