Medi-Cal Members: Starting January 1, 2022, Medi-Cal Pharmacy Benefits will be administered through the fee-for-service delivery system Medi-Cal Rx. Please visit the DHCS Medi-Cal Rx website for more information.
Special Notice: L.A. Care is encouraging members to use the mail order option to fill prescriptions at Quality Drug Clinical Care. There is more information in the blue box below. We also have frequently asked questions about this service.
Please look at the Quality Drug Clinical Care Mail Order FAQ for your specific plan:
- L.A. Care Covered and L.A. Care Covered Direct Member FAQs
- L.A. Care Medicare Plus Member FAQs
- PASC-SEIU Plan Member FAQs
An Important Pharmacy Change for Members
L.A. Care is providing members with mail order services through Quality Drug Clinical Care (Quality Drug). This is a free service to L.A. Care Medicare Plus, L.A. Care Covered, L.A. Care Covered Direct, and Homecare Workers Health Care plan members.
Members can get a 90-day supply (or 100-day supply for L.A. Care Medicare Plus members only) of maintenance medications through the mail-order pharmacy service or at a participating retail pharmacy location. Maintenance medications are drugs that may need to be taken for a long-term health condition, such as high blood pressure or diabetes. To sign up or learn more, call L.A. Care member services at:
Medicare Plus (HMO D-SNP): 1.833.522.3767 (TTY 711)
L.A. Care Covered™: 1.855.270.2327 (TTY 711)
PASC-SEIU: 1.844.854.7272 (TTY 711)
If the medication(s) has no refill(s) remaining, prescribers will need to provide a new prescription. If you prefer to mail in your prescription request to Quality Drug, you can print out the form below.
To find mail order pharmacies for Medi-Cal members, please refer to pharmacy search at the Medi-Cal Rx website and filter for mail order.
L.A. Care uses a list of covered drugs called a formulary. Drugs on the list have been chosen for their safety and effectiveness. Your doctor should order drugs from this approved list.
Each plan has its own formulary. You can check if your medication is covered by browsing the formulary document for your health plan listed here. L.A. Care can also provide a copy of the formulary in your preferred language, large print, audio, or alternate format.
L.A. Care Medi-Cal and Plan Partner Drug Coverage
Starting January 1, 2022 Medi-Cal Pharmacy Benefits will be administered through the fee-for-service delivery system Medi-Cal Rx. If you receive Medi-Cal health coverage through L.A. Care or a Plan Partner – Anthem Blue Cross, Blue Shield of California Promise Health Plan, or Kaiser Permanente – Please visit the DHCS Medi-Cal Rx website for more information.
Restrictions to Coverage
Restrictions to coverage apply to 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.
Formulary Updates – New drug additions and deletions
L.A. Care formularies are continually updated to provide safe, appropriate, and cost-effective drug therapies. These changes are listed in the documents below.
Prior Authorizations and Coverage Exceptions
One type of restriction is called a Prior Authorization (PA). Certain formulary medications require a written Prior Authorization (PA) request to be submitted by the prescribing practitioner for our L.A. Care members. Prior Authorizations are reviewed based on the individual member's need. Medications that are non-formulary require a written drug exception request, similar to a PA, to be submitted by the prescribing practitioner.
Policies regarding coverage exceptions vary by plan. Please refer to your member handbook for specific coverage exception information.
Medications that have a step therapy requirement will require you to try medications in a certain order. If your practitioner feels that you need to use a Step Therapy drug without first trying a first step drug, he or she can submit a Prior Authorization Form with documentation of the medical need.
Medications that have a designated quantity limit, require that only the specified maximum amount of medication be filled during a certain period of time. If your practitioner feels that your medical condition requires a quantity of medication exceeding the specified limit, he or she can submit a Prior Authorization Form, along with documentation of medical need.
Member cost share varies by plan. Please refer to your member handbook for specific cost share information.