Restrictions to Coverage and Coverage Exceptions
Restrictions to coverage apply for certain prescription drugs. The Pharmacy and Therapeutics Committee develops restrictions to help our members use drugs in the most safe and effective ways. Some restrictions impact overall drug cost, which keeps our members’ drug coverage more affordable. Other restrictions are designed to promote safe use of particular agents, such as opioids. If you need assistance with the drug exception request process, please contact L.A. Care Member Services, Provider line 866-522-2736.
You may also find the Medicare Prescription Drug Determination Request Form, specific to L.A. Care Medicare Plus members by visiting the Prescription Drug Prior Authorizations page.
Updates to the Formulary – New drug additions and deletions
L.A. Care Formularies are continually updated to provide safe, appropriate, and cost-effective drug therapies. L.A. Care encourages our network physicians and pharmacists to provide suggestions and comments for formulary additions and changes. If you would like to recommend that a specific drug be added to the formulary or coverage be changed for an existing drug, you may access the Formulary Drug Review Request Form found in the Resources box. If you have questions regarding formulary updates, please contact L.A. Care Member Services Provider Line at 866-522-2736.
You can view the latest changes to the formulary in the blue box below.