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.

• 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 or Step Therapy Exception 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.