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:
800-977-2273 or 711 for TTY
Pharmacy Prior Authorization Center for Major Risk Medical Insurance Program (MRMIP):
Pharmacy Prior Authorization Center for Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan):
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:
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.
- 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
- 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
- Log in to Availity
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- Learn about Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Reimbursement Policies
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