Pharmacy

Pharmacy Program at California Health & Wellness is to provide access to pharmacy services to our members, and to ensure that these services are a covered benefit, medically necessary, appropriate to the member’s condition, rendered in the appropriate setting, and meet professionally recognized standards of pharmacy care.

Preferred Drug List

California Health & Wellness has created a Preferred Drug List (PDL). The PDL is continually evaluated by a committee of practicing physicians and pharmacists to ensure appropriate and cost-effective use of medications without compromising the quality of care. Click on the link below to see the full list.

Epocrates
Preferred Drug List (PDL)
Provider Quick Reference Guide
Pharmacy PDL Change Request Form

Medication Prior Authorization Requests

Some medications require prior authorization from California Health & Wellness in order for reimbursement to be issued to the provider. Medications requiring prior authorization include:

• Medications not listed on the Preferred Drug List (PDL)
• Medications listed on the PDL with restrictions or limitations, such as:
• Step Therapy
• Quantity Limit
• Age Limit

Use the form below when submitting a prior authorization request for medications:

Prescription Drug Prior Authorization Request Form (No. 61-211)

Please note the contact information differs based on the type of prior authorization request being made:

* Please see the injectable medication HCPS/DOFR Crosswalk to determine provider-administered “therapeutic” vs. self-administered injectables.

NOTE: Enteral Nutrition 

• Submit Pump Enteral Nutrition Prior Authorizations to California Health & Wellness Pharmacy Department. Billing must be through California Health & Wellness Medical Billing.
• Submit Bolus (no pump) Enteral Nutrition Prior Authorizations to Envolve Pharmacy Solutions. Billing must be handled through a network pharmacy using pharmacy claims.  

Find a Provider

To find a pharmacy that is in the California Health & Wellness network you can use the Find a Provider tool. Choose Other and type the name of the pharmacy or select the pharmacy type in the Select Specialty area. Only those pharmacies in the California Health & Wellness network are listed.