PHARMACY SERVICES AND DRUG FORMULARIES

Pharmacy and Therapeutics Committee

The Pharmacy and Therapeutics Committee comprises a multidisciplinary team that meets quarterly to review the Medication Formulary and evaluate the quality of pharmaceutical care our Blue Shield Promise members receive. In addition to maintaining the formulary, the Pharmacy Department manages prior authorizations. This provides a process for physicians and pharmacies to submit requests for medications not currently included in the formulary.

Announcements

Medi-Cal pharmacy benefits now managed by Medi-Cal Rx
Beginning January 1, 2022, a state-run program called “Medi-Cal Rx” now manages Medi-Cal pharmacy benefits. The Department of Health Care Services (DHCS) administers the program through their vendor, Magellan Rx, which manages the dispute resolution process. To learn more, please visit the Medi-Cal Rx website or call them at (800) 977-2273, 24 hours a day, seven days a week, Monday through Friday, 8 a.m. to 5 p.m.

Drug formularies

• Medi-Cal Rx Contract Drugs list
• Cal MediConnect formulary
• Blue Shield Medicare formulary
• 2020-2021 archived formulary changes 
   

Cal MediConnect formulary changes

  Formulary changes for 3rd QTR 2022 (PDF, 89 KB)

  Formulary changes for 2nd QTR 2022 (PDF, 135 KB)

  Formulary changes for 1st QTR 2022 (PDF, 120 KB)
 

​Prescription drug prior authorization form

This form is for participating physicians and pharmacies to obtain medications that are not on the Formulary or require prior authorization.

   Prescription drug prior authorization or step therapy exception request form (PDF, 1.4 MB)
 

Additional pharmacy services

Mail service pharmacy

Your patients can have their maintenance medications delivered to their home or office through CVS Caremark Mail Service Pharmacy with no charge for shipping or delivery.

CVS Caremark Mail Service Pharmacy
  Phone: (866) 346-7200 (TTY: 711)
 Website: www.caremark.com/wps/portal
 

Specialty pharmacies

All our network specialty pharmacies, including CVS Specialty pharmacy, are available to all Blue Shield Promise Cal MediConnect members. Physicians may call or fax their patient’s prescription to any specialty pharmacy in our network.

CVS Specialty pharmacy
  Phone:(800) 237-2767 (TTY: 711)
 Fax: (800) 323-2445
 Website: www.cvsspecialty.com

Got questions?

For any questions regarding prescriptions or our drug formularies, please call Provider Services:

 Phone: (800) 468-9935, 6 a.m. to 6:30 p.m., Monday through Friday.

Provider Connection
Access network provider tools on Provider Connection website.