Prescriptions & Pharmacies: Medi-Cal Rx
Drug 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 drug benefits.
HPSM, however, still covers drugs given by a provider in an office or clinic setting. These drugs 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 drug 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 drug benefits! Plus, you'll pay low or no drug co-pays and get coverage for an additional 1,300 over-the-counter drugs, vitamins and medical supplies!