Changes to Medi-Cal Pharmacy Services
On January 1, 2022, the State of California Medi-Cal
Program started a new program called MediCal Rx.
This new program will now manage all prescription
medications for Medi-Cal patients. Some
medications are no longer covered by the new
Medi-Cal program and your provider may need to
change some of your prescriptions to similar
medicines that will be covered. Even if a medication
is covered, the quantity of medication allowed by
Medi-Cal may change. Our clinic and providers
appreciate your patience and understanding as we
make adjustments to follow the new Medi-Cal requirements. We thank you again for choosing T.H.E. to support your health and wellness.
Who is NOT affected by this change? This change will not affect Medi-Cal beneficiaries are
enrolled in the following programs or plans: Programs of All-Inclusive Care for the Elderly (PACE) plans, Senior Care Action Network (SCAN) and Cal MediConnect health plans, or the
Major Risk Medical Insurance Program (MRMIP) are not affected. These beneficiaries will
continue to get their prescription drugs through these plans instead of the Medi-Cal Rx
Who can beneficiaries call for help with Medi-Cal prescription drugs?
Call Customer Service at 1-800-977-2273 twenty-four hours a day, seven days a week or 711 for TDD Monday thru Friday, 8am to 5pm.
What can beneficiaries do if Medi-Cal Rx says “no” to the prescriptions?
There are 3 steps a beneficiary should take:
(1) Talk to their doctor or pharmacist to see if they say why they can’t fill the prescription. They may be able to help resolve the problem or find another drug that will work.
(2) Call the Medi-Cal Rx Customer Service at 1-800-977-2273 and ask them to reconsider their decision. If they need help, they can ask their doctor or someone else to help them.
(3) If they disagree with the decision, file an appeal with Medi-Cal Rx by Requesting a State Fair Hearing. In a State Hearing, a judge reviews your request and makes a decision. If Medi-Cal Rx says “no”, they must give you a written notice of the reason they said no and tell you about your options to appeal.