Pharmacy Services

See Section 4 in your Handbook to learn about Prescription Drug coverage.

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

How to Get Prescriptions Filled

If you have a prescription that needs to be filled, you should take it to one of the pharmacies on the pharmacy list that PHC sent you. If you do not have the copy we sent you, you can get a copy of our contracted pharmacies from the section of this web site titled "provider directories" or you can call the PHC Member Services Department.

Getting your prescription filled

You should never have to pay for a prescription that is covered and medically necessary. If you are having a problem getting a prescription or you had to pay for a prescription, you should call our Member Services Department right away. Our phone number is (800) 863-4155.

PHC only covers brand name drugs when a generic equivalent drug is not available. However, if there is a medical reason why a generic drug may not be used, a request for authorization must be submitted to PHC indicating the medical reason.

Below are some tips on getting prescriptions filled more quickly and easily:

    • Always present all of your health insurance cards, including your PHC ID card and your Medi-Cal card.
    • Find a pharmacy that you like and when possible get your prescriptions filled there.
    • Listen and follow the pharmacist's instructions about how often you should take your medicine.
    • Call ahead to your pharmacy when you need a refill. Don't wait until you run out of medicine. You should call when 75% of your prescription is gone.
    • Managing Pain Safely Fact Sheet for Members, Click Here.

If you have a problem getting your prescription filled, you should:

• Ask to speak to the head pharmacist or pharmacy manager.

• Call our PHC Members Services Department at (800) 863-4155.

 

 

​​Click here for the PHC Drug Formulary​​​

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​Pharmacy Services

PHC keeps a list of drugs called a "Drug Formulary." PHC's Pharmacy and Therapeutics Committee meets quarterly to review and revise the formulary. Drugs are evaluated and selected for the formulary based on safety, quality, effectiveness and affordability. In some cases your doctor may choose to prescribe a drug that is not on the formulary. In order for this drug to be covered, your doctor must obtain approval form PHC before your prescription is filled.

If you would like a copy of the PHC's Drug Formulary, you can contact the PHC's Member Services Department. The formulary is also available on the web site.

Pharmacy – Mail Order Home Delivery

PHC wants to make it easier for you to get your prescriptions. With Alliance Rx, Walgreens Prime mail order home delivery, you can get up to three months of covered, generic maintenance drugs shipped to your home or other place that you tell us. Maintenance drugs are for chronic or long-term health problems like high cholesterol, diabetes, high blood pressure and birth control. 

Some of the benefits of mail order home delivery include: 

    • 24/7 Pharmacist Advice Line
    • Lower Risk of Running Out or Missing a Prescription Medication Dose 
    • Free Standard Shipping
    • Online Auto Refills
    • Checking  Order or Refill Status

Getting started is easy. For more details call:

    • Alliance Rx Walgreens Prime (800) 345-1985
    • TTY (800) 573-1833

 

​Current Formulary Changes

To see the most current formulary changes, please click on the link below and then click on "additions/changes" under the most current P&T date.

If you would like a copy of the current formulary changes, you can also contact PHC's Member Service Department

http://www.partnershiphp.org/Providers/Pharmacy/Pages/PT-Formulary-Changes.aspx

​Drug Recalls and Withdrawals

 

What is a drug recall?

A drug recall occurs when a medication is removed from the market because it is deemed to be defective or possibly harmful. A market withdrawal occurs when a product has a minor violation that would not be subject to FDA legal action. The company removes the product from the market or corrects the problem. The FDA issues a notification to inform healthcare providers, hospitals, and others about medication safety issues or concerns. 

PHC works closely with pharmacies and providers to make sure the medications you take are safe. When we are notified that a medication has a potential problem, we will notify you and your prescriber right away.

Click here to view the latest list of drug recalls and withdraws.