PHARMACY SERVICES AND DRUG FORMULARIES

Pharmacy and Therapeutics Committee

The Pharmacy and Therapeutics Committee comprises a multidisciplinary team that meets quarterly to review the Medication Formulary and evaluate the quality of pharmaceutical care our Blue Shield Promise members receive. In addition to maintaining the formulary, the Pharmacy Department manages prior authorizations. This provides a process for physicians and pharmacies to submit requests for medications not currently included in the formulary.

Announcements

Medi-Cal pharmacy benefits now managed by Medi-Cal Rx
Beginning January 1, 2022, a state-run program called “Medi-Cal Rx” now manages Medi-Cal pharmacy benefits. The Department of Health Care Services (DHCS) administers the program through their vendor, Magellan Rx, which manages the dispute resolution process. To learn more, please visit the Medi-Cal Rx website or call them at (800) 977-2273, 24 hours a day, seven days a week, Monday through Friday, 8 a.m. to 5 p.m.

Drug formularies

Cal MediConnect formulary changes

  Formulary changes for 3rd QTR 2022 (PDF, 89 KB)

  Formulary changes for 2nd QTR 2022 (PDF, 135 KB)

  Formulary changes for 1st QTR 2022 (PDF, 120 KB)
 

​Prescription drug prior authorization form

This form is for participating physicians and pharmacies to obtain medications that are not on the Formulary or require prior authorization.

   Prescription drug prior authorization or step therapy exception request form (PDF, 1.4 MB)
 

Additional pharmacy services

Mail service pharmacy

Your patients can have their maintenance medications delivered to their home or office through CVS Caremark Mail Service Pharmacy with no charge for shipping or delivery.

CVS Caremark Mail Service Pharmacy
  Phone: (866) 346-7200 [TTY: 711]
 Website: www.caremark.com/wps/portal
 

Specialty pharmacies

All our network specialty pharmacies, including CVS Specialty pharmacy, are available to all Blue Shield Promise Cal MediConnect members. Physicians may call or fax their patient’s prescription to any specialty pharmacy in our network.

CVS Specialty pharmacy
  Phone:(800) 237-2767 [TTY: 711]
 Fax: (800) 323-2445
 Website: 

www.cvsspecialty.com

Got questions?

For any questions regarding prescriptions or our drug formularies, please call Provider Services:

 Phone: (800) 468-9935, 6 a.m. to 6:30 p.m., Monday through Friday.

Find a pharmacy

Use our online tool to find a network retail pharmacy.

Find a Medi-Cal Rx pharmacy
Find a Cal MediConnect pharmacy

Drugs and pharmacy information for members

Review the drug and pharmacy information available to our members.

Cal MediConnect drugs and pharmacy benefits

Provider Connection
Access network provider tools on Provider Connection website.

Access Provider Connection

Health Care Options: 1-844-580-7272, de lunes a viernes, de 8:00 a. m. - a 6:00 p. m. Los usuarios del sistema TTY deben llamar al 1-800-430-7077.

Para obtener información sobre Blue Shield Promise Cal MediConnect Plan y otras opciones de Cal MediConnect para la atención de su salud, comuníquese con el Department of Health Care Services (Departamento de Servicios de Atención de la Salud) al 1-800-430-4263 (TTY: 1-800-735-2922) o visite la página https://www.healthcareoptions.dhcs.ca.gov/.

Blue Shield of California Promise Health Plan es una organización de atención administrada que pertenece completamente a Blue Shield of California, y que ofrece Medi-Cal, Cal MediConnect, Medicare Advantage HMO y Dual Eligible Special Needs Plans (D-SNP, Planes de necesidades especiales con doble elegibilidad).

© 2002-2023. California Physicians’ Service DBA Blue Shield of California Promise Health Plan. Todos los derechos reservados.

California Physicians’ Service DBA Blue Shield of California Promise Health Plan es un licenciatario independiente de Blue Shield Association..

Blue Shield of California Promise Health Plan es un plan HMO y un plan HMO D-SNP que tiene un contrato con Medicare y un contrato con el Programa Medicaid del Estado de California. La inscripción en Blue Shield of California Promise Health Plan depende de la renovación del contrato.

Las redes de proveedores pueden cambiar en cualquier momento.

Blue Shield of California Promise Health Plan complies with applicable state laws and federal civil rights laws, and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability.

Blue Shield of California Promise Health Plan cumple con las leyes estatales y las leyes federales de derechos civiles vigentes, y no discrimina por motivos de raza, color, país de origen, ascedencial, religión, sexo, estado civil, genero, identidad de genero, orientación sexual, edad ni discapacidad.

Blue Shield of California Promise Health Plan 遵循適用的州法律和聯邦公民權利法律，並且不以種族、膚色、原國籍、血統、宗教、性別、婚姻 狀況、性別認同、性取向、年齡或殘障為由而進行歧視。

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