Pharmacy

The Pharmacy Program at California Health & Wellness is designed 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.

• Preferred Drug List (PDL) (PDF)
• Pharmacy PDL Change Request Form (PDF)

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 or Step Therapy Exception Request Form (No. 61-211) (PDF)

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

Self-Administered Non-Specialty Medications

Envolve Pharmacy Solutions

Envolve Pharmacy Solutions, California Health & Wellness Pharmacy Benefit  Manager, processes pharmacy claims and administers the prior authorization process for self-administered (i.e. oral, self-injectable, topical, ophthalmic) drugs.

Fax: 1-866-399-0929
Phone: 1-877-277-0413

Self-Administered Specialty Medications

AcariaHealth

AcariaHealth, California Health & Wellness preferred specialty pharmacy vendor, can supply a number of specialty medications. Requests for specialty medications are screened by AcariaHealth prior to review by US Script.

Fax: 1-855-217-0926
Phone: 1-855-535-1815

Physician-Administered Specialty Medications

California Health & Wellness Pharmacy Department

The California Health & Wellness Pharmacy Department handles prior authorization requests for medications 
that will be administered by a provider (i.e. biopharmacy, home health, outpatient, injectable or infusible medications).

Fax: 1-877-259-6961
Phone: 1-877-658-0305

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

AcariaHealth is the Preferred Specialty Pharmacy for California Health & Wellness. Please contact AcariaHealth by phone at 1-855-535-1815 to coordinate delivery of Specialty medications.

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.