MEDI-CAL RX
Since January 1, 2022, the Department of Health Care Services (DHCS) manages your pharmacy benefit through the state-run program called Medi-Cal Rx.
This means that you get most of your Medi-Cal-covered prescriptions through Medi-Cal Rx when you get them from a pharmacy.
Medi-Cal Benefits Identification Card (BIC)
You need to show your Medi-Cal Benefits Identification Card (BIC) when you go to the pharmacy. The pharmacy may use your BIC to look up your information and give you your medications.
Benefits Identification Card sample, front
Benefits Identification Card sample, back
Blue Shield Promise member ID card
You will need to show your Blue Shield Promise member ID card when you go to your doctor or hospital.
Always carry both your Blue Shield Promise ID member card and your BIC with you.
Los Angeles County member ID card sample, front
Los Angeles County member ID card sample, back
San Diego County member ID card sample, front
San Diego County member ID card sample, back
Physician-administered drugs
Some drugs are covered by your Blue Shield of California Promise Health Plan (Blue Shield Promise) rather than Medi-Cal Rx. These are drugs given to you by a medical healthcare provider, like a doctor or nurse. They are called physician-administered drugs (PADs). PADs can be given to you at a doctor’s office or infusion center, or at home with a home infusion provider.
To learn more about PADs, see the Frequently asked questions (FAQs) below. You can also view this flyer: Blue Shield Promise PADs (PDF, 78 KB).
Need help with Medi-Cal Rx?
If you have questions about Medi-Cal Rx, call the Medi-Cal Rx Customer Care Center at (800) 977-2273, 24 hours a day, seven days a week. Use 711 for TTY, 8 a.m. to 5 p.m., Monday through Friday. They can also help you with pharmacy complaints, appeals, and grievances.
Frequently asked questions (FAQs):
How do I access my pharmacy benefits?
You need to show your Medi-Cal BIC when you go to the pharmacy. The pharmacy may use your BIC to look up your information and give you your medications.
How can I get a new Medi-Cal BIC?
If you do not have a BIC, or if it is lost or stolen, you may ask for a replacement from:
Los Angeles County Department of Public Social Services Customer Service Center: (866) 613-3777
San Diego County Department of Health & Human Services Agency Customer Service Center: (866) 262-9881
How do I find a pharmacy?
You can use the Find a Medi-Cal Rx Pharmacy Locator tool at Medi-CalRx.dhcs.ca.gov.
You can also call Medi-Cal Rx Customer Service Center (CSC) at (800) 977-2273, 24 hours a day, seven days a week. Use 711 for TTY, 8 a.m. to 5 p.m., Monday through Friday.
What if I have a problem with my pharmacy benefits?
For complaints, appeals, and grievances about your pharmacy benefits, please call:
- Medi-Cal Rx Customer Service Center at (800) 977-2273, 24 hours a day, seven days a week. Use 711 for TTY, 8 a.m. to 5 p.m., Monday through Friday.
Can I email my questions, complaints, appeals, and grievances to Medi-Cal Rx?
Yes, you can. Do NOT include personal information in your first email. Tell them you are writing about Medi-Cal Rx. DHCS staff will reply from a secure email address. If they need your personal information, they will ask for it then.
Email your questions, complaints, appeals, and grievances to DHCS at RxCarveOut@dhcs.ca.gov.
What are physician-administered drugs?
Physician-administered drugs (or PADs) are drugs administered (given to you) by a medical healthcare provider, like a doctor or nurse. This may happen at a doctor’s office or infusion center, or at home with a home infusion provider.
How are my PADs covered?
Your physician-administered drugs (PADs) are covered by Blue Shield Promise. These drugs are not covered by your pharmacy benefit.
Is there anything different I have to do to get my PADs?
No, you do not have to do anything special to get your physician-administered drugs (PADs). Because PADs are given to you by your medical healthcare provider when needed, you do not have to go to a pharmacy or order these drugs by mail.
Does my doctor or pharmacy know about PADs?
Yes. DHCS and Blue Shield Promise have informed providers about PADs and how they should bill for them.
Do I need prior authorization (approval) from Blue Shield Promise before I start getting PADs? Do I need to submit an approval to Blue Shield Promise?
Before you start getting physician-administered drugs, you may need permission from Blue Shield Promise. Your doctor will ask for you. This is called asking for prior authorization (or pre-approval). It is the way that Blue Shield Promise makes sure this care is medically necessary (or needed for you). You do not need to submit anything.
For more information, please visit:
- Blue Shield Promise physician-administered drugs (PAD) flyer (PDF, 78 KB)
- Medi-Cal Rx member and provider website: Medi-CalRx.dhcs.ca.gov
- Medi-Cal Rx transition page on the DHCS website
Blue Shield of California Promise Health Plan is an independent licensee of the Blue Shield Association.
Blue Shield of California Promise Health Plan is contracted with the Department of Health Care Services (DHCS) to provide managed care services in San Diego County. Blue Shield of California Promise Health Plan is contracted with L.A. Care Health Plan to provide Medi-Cal managed care services in Los Angeles County.