Prescriptions & Pharmacies: Medi-Cal Rx
Medicine benefits for Medi-Cal members
Pharmacy services for Medi-Cal and California Children’s Services (CCS) members are primarily managed by the California Department of Health Care Services (DHCS) through a program called Medi-Cal Rx. A contractor called Magellan Medicaid Administration, Inc. (Magellan) works with DHCS to provide coverage for medicine benefits.
HPSM, however, still covers medicines given by a provider in an office or clinic setting. These medicines are sometimes called physician administered drugs (PADs) and may require pre-approval (also known as prior authorization) from HPSM for coverage based on medical necessity. Learn more about PADs.
For questions about how to obtain coverage, contact HPSM Member Services at 650-616-2133. Call Center hours are Monday through Friday from 8:00 a.m. to 6:00 p.m.
Information about Medi-Cal Rx is below. If you have more questions about your medicine benefits after reading it, call 1-800-977-2273 (TTY users: dial 7-1-1) or visit DHCS's Medi-Cal Rx website.
If you have HPSM Medi-Cal and Medicare, you can join HPSM’s CareAdvantage plan! If you join, then CareAdvantage will manage your medicine benefits! Plus, you'll pay low or no medicine co-pays and get coverage for an additional 1,300 over-the-counter medicines, vitamins and medical supplies!