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.
Medi-Cal Rx Transition
Effective April 1, 2021 Medi-Cal pharmacy benefits and services will transition from managed care to the State’s responsibility under the pharmacy benefit program known as Medi-Cal Rx.
The State has selected Magellan Medicaid Administration, Inc. (Magellan) as the contractor to administer Medi-Cal Rx.
Please read the Provider Update letter to find out more about this change.
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)
- Preferred Drug List (PDL) (JSON) (machine readable file)
- 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.