Pharmacy Information

Effective January 1, 2022, the Department of Health Care Services (DHCS) will transition all administrative services related to Medi-Cal Managed Care (Medi-Cal) pharmacy benefits billed on pharmacy claims from the existing fee-for-service fiscal intermediary (FI) under Medi-Cal or the member’s managed care plan to DHCS’ new pharmacy vendor/FI for Medi-Cal, Magellan Medicaid Administration, Inc. (Magellan).

All pharmacy services billed as a pharmacy claim (and their electronic equivalents), including outpatient drugs (prescription and over the counter), physician- administered drugs (PADs), medical supplies, and enteral nutritional products are in scope for pharmacy under Medi-Cal.

Pharmacy services billed as a medical (professional) or institutional claim (or their electronic equivalents) are not in scope.

Pharmacy contact information after January 1, 2022

Pharmacy prior authorization

Pharmacy Prior Authorization Center for Medi-Cal:

Hours: 24 hours a day, seven days a week
 

Phone:

800-977-2273 or 711 for TTY

Pharmacy Prior Authorization Center for Major Risk Medical Insurance Program (MRMIP):

Hours: Monday through Friday from 7 a.m. to 7 p.m. PT
 

Phone:

844-410-0746

Fax:

844-474-3345

Pharmacy Prior Authorization Center for Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan):

Phone:

855-817-5786

Fax:

800-359-5781

Note: For Synagis or other medical injectable drug prior authorizations, please call 1-866-323-4126.

Pharmacy Benefits Manager

To verify Medi-Cal pharmacy network participation or pharmacy drug coverage under Medi-Cal, please call the Pharmacy Benefits Manager:
 

Phone:

800-977-2273

TTY:

711

How to use the Anthem Blue Cross Cal MediConnect Formulary

The Anthem Blue Cross Cal MediConnect Plan Formulary lists the brand name or generic name of a given drug. If a medication does not appear on this formulary, a prescription drug prior authorization form will need to be completed by the prescriber and submitted to Anthem Blue Cross (Anthem) before the prescription may be filled.

Use the formulary to search by drug name or disease category:

For Medi-Cal drug coverage, please use the Medi-Cal Contract Drug List. Visit the  Medi-Cal pharmacy website for more information.

 Where to get prescriptions filled
  • For MRMIP and MMP: Prescriptions can be filled at more than 5,000 retail pharmacies in California and a listing of these pharmacies (pharmacy network) can be found in our provider directories.
  • For Medi-Cal: Call Customer Service at 800-977-2273

Medical injectables

Office-based injectables:

  • Drugs requiring the assistance of a medical professional (office-based injectables) are not covered under the pharmacy benefit. 
  • Medically necessary office-based injectables are covered under the major medical benefit.

Please refer to the Provider Manual for more details on medical coverage:

 

Related pharmacy resources:

Provider tools & resources

Interested in becoming a provider in the Anthem network?

We look forward to working with you to provide quality services to our members.

Join our network