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Medi-Cal Rx pharmacy benefits

Starting January 1, 2022, the Medi-Cal pharmacy benefits and services are carved out and administered through the fee-for-service (FFS) delivery system by the Department of Health Care Services (DHCS). The carved-out pharmacy benefit is now known as Medi-Cal Rx. Magellan provides the administrative services, as directed by DHCS. And physician-administered drugs (PADs) billed as a medical benefit are still covered by Aetna Better Health® of California. You can visit the Medi-Cal Rx Homepage or Bulletins & News page for more information.

Transition policy lift

Starting March 24, 2023, Medi-Cal Rx will begin a series of medication transition policy lifts for patients age 22 and older. Prior authorization (PA) may be required for your patients’ medications that were grandfathered due to the transition policy.


  • If your patients are age 22 and older, you can have them switch to covered alternatives that may not require PA.
  • If a covered alternative is not appropriate, you can submit an early PA request to Medi-Cal Rx (effective February 24, 2023).

Lift number: 1


  • Effective date: March 24, 2023
  • Drug classes:
    • Anticoagulants and antiplatelets
    • Antihypertensives
    • Anti-lipemic agents
    • Benzodiazepines
    • Cardiovascular agents
    • Coronary vasodilators
    • Diuretics
    • Hypoglycemics
    • Niacin, vitamin B and vitamin C
    • Opioids


Lift number: 2


  • Effective date: April 21, 2023
  • Drug classes:
    • Anti-Parkinson’s
    • Biologic agents
    • Contraceptives and hormones
    • Dermatologic agents
    • Glucocorticoids and corticotropins
    • Ophthalmic, nasal, and otic preparations
    • Thyroid agents
    • Topical anesthetic agents

Want to learn more? Just visit DHCS Medi-Cal Rx — Bulletins & News and see the “Reinstatement Spotlight” weekly notices.

Contact us

Questions? Just call Provider Relations at 1-855-772-9076 (TTY: 711). We’re here for you Monday through Friday, 8 AM to 5 PM.

Understanding Medi-Cal Rx pharmacy benefits

Understanding Medi-Cal Rx pharmacy benefits

When billed by a pharmacy on a pharmacy claim, Medi-Cal Rx is responsible for handling:


  • Covered outpatient drugs
  • Specific medical supply
  • Enteral nutritional products


The Contract Drug List (CDL) is a list of drugs that are covered by Medi-Cal Rx. To see the complete CDL, visit DHCS Medi-Cal Rx — Contract Drugs List.


To see which medications require PA, visit DHCS Medi-Cal Rx — Contact Drugs List and choose “Medi-Cal Rx Approved NDC List.”


Questions about Medi-Cal Rx pharmacy benefits?


Just call the Medi-Cal Rx Customer Service Center (CSC) line at 1-800-977-2273. You can call 24 hours a day, 7 days a week.

We'll continue to cover physician-administered drugs (PADs) if they are billed under the medical benefit.


Medical pharmaceutical management


Coverage determinations for PADs billed under the medical benefit are subject to medical necessity review by a group of clinicians, including pharmacists and nurses. Criteria used to review for medical necessity may include:



Providers and members have the right to appeal an adverse determination. You can refer to the Notice of Action letter to learn more about the appeals process.

Need to learn more about medication recalls? Just call the U.S. Food and Drug Administration (FDA) at 1-888-463-6332. Or visit FDA — Drug Recalls.

Links and resources

Homepage Learn more about Medi-Cal Rx pharmacy benefits.

Find a Pharmacy  Locate a pharmacy in Medi-Cal Rx’s network by using the Find a Pharmacy tool on the DHCS Medi-Cal Rx website. You can filter for services such as mail order or mail delivery. The website may not show all pharmacies offering mail order services, so your patient may want to first call the pharmacy to check if the service is provided.

Provider Manual Providers of FFS Medi-Cal Rx pharmacy programs can refer to this manual for claims submission guidelines.

Bulletins & News See Medi-Cal Rx updates and news for providers.

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