View medical benefit drug policy, as well as medication and treatment documents, for Blue Shield of California Promise Health Plan Medi-Cal members.
Medical benefit drug policy for Medi-Cal plans
Please be aware that all medical benefit specialty drugs will require prior authorization review for Medi-Cal members.
This section is updated frequently and may not contain policies for all the medical benefit specialty drugs that require prior authorization. If there is no policy here for a certain specialty drug, coverage will be determined based on medical necessity.
Medical necessity determinations are made based on U.S. Food and Drug Administration (FDA) labeling, peer-reviewed medical literature, Medi-Cal coverage guidelines, and Centers for Medicare & Medicaid Services (CMS) approved compendia support i.e., Clinical Pharmacology, National Comprehensive Cancer Network® (NCCN), American Hospital Formulary Service Drug Information, Thomson Micromedex DrugDex,®¹ and Lexicomp®.
¹ DrugDex is a registered trademark owned by Lendac Data Systems, Ltd.
² National Comprehensive Cancer Network is a registered trademark of the National Comprehensive Cancer Network, Inc.
³ Lexicomp is a registered trademark of Wolters Kluwer.
Medication and treatment policy documents
Find medical benefit drug policy documents for Medi-Cal plans.