PHARMACY SERVICES AND DRUG FORMULARIES
Pharmacy and Therapeutics Committee
The Pharmacy and Therapeutics Committee comprises a multidisciplinary team that meets quarterly to review and evaluate the quality of pharmaceutical care our Blue Shield Promise members receive. The Pharmacy Department also manages prior authorizations. This provides a process for physicians and pharmacies to submit requests for medications administered on the medical benefit.
For more information, please visit the Medication Policy page on the Provider Connection website.
Medi-Cal pharmacy benefits managed by Medi-Cal Rx
On January 1, 2022, a state-run program called “Medi-Cal Rx” began managing 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.
Cal MediConnect discontinued
Effective January 1, 2023, Cal MediConnect plans were discontinued throughout California. Blue Shield Promise Cal MediConnect members in Los Angeles and San Diego counties were transitioned to the Blue Shield TotalDual (HMO D-SNP) plan.
- Medi-Cal Rx Contract Drugs list
- Cal MediConnect formulary (for dates of service through December 31, 2022)
- 2020-2022 archived formulary changes
For any questions regarding Medi-Cal prescriptions, please contact Medi-Cal Rx.
For any questions regarding drugs administered as medical benefits, please call Provider Services:
Phone: (800) 468-9935, 6 a.m. to 6:30 p.m., Monday through Friday.
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