Check the List of Covered Drugs
Some medications need pre-approval from Magellan before you can get them. The list of drugs that Medi-Cal Rx covers without pre-approval may be different than the drug list HPSM uses.
Most people will not have any change in their medications. To make sure you are ready for this change you should check to see:
- if your medications are not on the list of drugs covered by Medi-Cal Rx. If your medication is not on the list, talk to your doctor right away.
- if you need pre-approval for your medications.
Enter the name of a medication in the search field to find out if it is on the list of covered drugs.
Even though your medication does not require pre-approval now, it may require pre-approval after January 1, 2022. If your pre-approval request is denied, ask your doctor about other drugs 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 drug 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 medication 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 medication that doesn’t need pre-approval. Your doctor and pharmacy will know about this change.
Existing medications 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 drugs, there will be a 180-day period during which pre-approval
will not be needed if the drug was previously covered by HPSM. But after June 29, 2022, your medication might require pre-approval from Magellan for payment if it is not on the Medi-Cal Rx list of covered drugs. If one or more of your drugs need
pre-approval, make sure you talk to your doctor before June 29 so that you can get your prescriptions when you need them.