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.
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:
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.
Self-Administered Specialty Medications
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.
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).
* 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.