Check the List of Covered Medicines
Some Medicines need pre-approval from Magellan before you can get them. The list of medicines that Medi-Cal Rx covers without pre-approval may be different than the medicine list HPSM uses.
Most people will not have any change in their medicines. To make sure you are ready for this change you should check to see:
- if your medicines are not on the list of medicines covered by Medi-Cal Rx. If your medicine is not on the list, talk to your doctor right away.
- if you need pre-approval for your medicines.
Enter the name of a medicine in the search field to find out if it is on the list of covered medicines.
Up until December 31, 2021, HPSM managed Medi-Cal members' medicine benefits. If your pre-approval request for a medicine you used to get through HPSM is denied, ask your doctor about other medicines you can take that are on the Medi-Cal Rx list. If you and/or your doctor strongly believe you need to keep taking a specific medicine that is not on Medi-Cal Rx’s list and your case is not moving forward, call HPSM and we will try to help.
If you are on a medicine that needs pre-approval, your doctor or pharmacy will have to fill out a form and get approval when you refill your prescription. Your doctor might also talk to you about changing to a similar medicine that doesn’t need pre-approval. Your doctor and pharmacy will know about this change.
Existing medicines will have a 180-day grace period during which pre-approval will NOT be required To give Medi-Cal members time to check the Medi-Cal Rx list of covered medicines, there will be a 180-day period during which pre-approval
will not be needed if the medicine was previously covered by HPSM. But after June 29, 2022, your medicine might require pre-approval from Magellan for payment if it is not on the Medi-Cal Rx list of covered medicines. If one or more of your medicines need
pre-approval, make sure you talk to your doctor before June 29 so that you can get your prescriptions when you need them.