Appeals and Complaints

What happens if you have a complaint about how your pharmacy services are handled

Magellan will accept and resolve your complaint. HPSM will no longer handle pharmacy complaints or appeals as of January 1, 2022. You can submit a complaint either in writing or by telephone by going to DHCS's Medi-Cal Rx website or calling Customer Service at 1-800-977-2273. (Note: You can only use this website and phone number to file a complaint after January 1, 2022.)

How to appeal a pharmacy benefit decision

If you do not agree with a denial or change of a medication under Medi-Cal Rx, talk to your provider to have them submit an appeal through the Department of Health Care Services (DHCS).

You can also ask for a State Fair Hearing with the California Department of Social Services.

If a service is denied or changed, a form to request a State Fair Hearing will automatically be sent to you with the notice of denial or change. You can also download and print the State Hearing Request form, complete it and send it to:

California Department of Social Services
State Hearings Division
P.O. Box 944243, MS 19-37
Sacramento, CA 94244-2430

You may also call to ask for a State Fair Hearing toll-free at 1-800-952-5253 (TTY: 1-800-952-8349). Please note that the number can be very busy so you may get a message to call back later.

After January 1, 2022, you can also get the form by going to www.Medi-Cal.Rx.dhcs.ca.gov or by calling Medi-Cal Rx Customer Service at 1-800-977-2273 or 711 for TTY. 

Deadlines for submitting State Hearing requests

  • You must submit your request for a State Hearing within 90 days of the date you received the denial letter from Magellan. Note: During the COVID-19 public health emergency, this deadline has been extended to 120 days. 
  • If you are already taking a medication and you want to continue taking the medication while you are waiting for your appeal, you must submit your request for a State Hearing within 10 days from the date of the denial letter. Include on your request form that you want “aid paid pending.”
  • The Department of Social Services will process your State Hearing within 90 days of when you submit your request. This means that it might take 90 days or longer before you get your medication. If this is the case, talk to your doctor about other treatment options and other medications you could take.