Medi-Cal offers pharmacy services as one of the program's many benefits. Starting January 1, 2022, your pharmacy benefit will be provided by the Department of Health Care Services (DHCS) instead of Partnership HealthPlan of California (PHC). Your prescription medications will be covered by Medi-Cal Rx. Read More
You can call the Medi-Cal Rx Call Center Line (800)-977-2273, 24-hours a day, 7-days a week, or 711 for TTY, Monday thru Friday, 8 a.m. to 5 p.m.
You can find a list of pharmacies that work with Medi-Cal Rx in the Medi-Cal Rx Pharmacy Directory at https://medi-calrx.dhcs.ca.gov/home/.
Medi-Cal Rx-The New Pharmacy Benefit
Starting January 1, 2022, you may have noticed changes when you picked up drugs at the pharmacy. Medi-Cal is now your pharmacy benefit provider instead of Partnership HealthPlan of California (PHC). The new Medi-Cal pharmacy benefit is called Medi-Cal Rx. Medi-Cal Rx will decide which drugs and how much of each drug are covered. You may need a TAR (Treatment Authorization Request) for some drugs to be covered. Magellan Medicaid Administration Inc. works with Medi-Cal to review and approve TARs.
It is important to work with your doctor and pharmacy. If your drugs are not covered by Medi-Cal Rx, your doctor or pharmacy will send TARs to Magellan. A big change is with Magellan member services. You can call Magellan 24 hours per day, 7 days a week at (800) 977-2273. They can answer your questions and solve any problems you have with getting your drugs at the pharmacy. If you have problems reaching Magellan or need more help with pharmacy issues, PHC will always be here to help you work with Magellan on any pharmacy questions or problems. Please call us at (800) 863-4155.
PHC's "Medical Drug Benefit"
You likely get most of the drugs your doctor prescribes at a pharmacy. You might get some drugs at your doctor's office or a hospital. Most of the time, your doctor will give you an injection (shot) of these drugs. Drugs you get at the doctor's office or hospital are covered by Partnership HealthPlan of California's (PHC's) medical drug benefit. Medi-Cal Rx covers drugs you get from a pharmacy.
PHC decides which drugs and how much of each are covered by the medical drug benefit. PHC reviews Treatment Authorization Requests (TARs) for these medicines. If you have questions about drugs you get at the doctor's office or hospital, or the PHC medical drug benefit, please call us at (800) 863-4155.
If you want a copy of what PHC needs to cover the drugs you get at your doctor's office, please call us at (800) 863-4155.
You can find updates and changes to the Pharmacy & Therapeutics (P&T) Drug Benefit on the Drug Benefit Updates webpage. Updates are posted 4 times each year at http://www.partnershiphp.org/Providers/Pharmacy/Pages/PT-Formulary-Changes.aspx
You can find the PHC Covered Drug Lists webpage at http://www.partnershiphp.org/Providers/Pharmacy/Pages/Formularies.aspx
On this page, you will find: (1) Changes to the drugs you get at your doctor's office, clinic or hospital; (2) the list of Medi-Cal covered medical drugs; and (3) the State Medi-Cal RX covered drug lists.
You can find TARs for both PHC medical drugs and Medi-Cal Rx pharmacy drugs at http://www.partnershiphp.org/Providers/Pharmacy/Pages/Prior-Authorization-Forms.aspx