Pharmacy Program

Your pharmacy and medication benefits

CalOptima has a list of drugs covered (paid for) by CalOptima if you fill it at a network pharmacy that works with CalOptima. This list is called the Approved Drug List. You are not responsible for drug costs. To find a pharmacy, please use the online Pharmacy search or read the Provider Directory in your member packet.

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Find a pharmacy Use the search tool to find a network pharmacy near you.

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Download the Approved Drug List Download PDF Icon You are not promised a drug because it is on the Approved Drug List.

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Download the Step and Contingent Therapy List Download PDF Icon For some conditions, you may be required to first try a less expensive drug on the this list that has proven effective for most people. This is called Step or Contingent Therapy.

How to request drugs that are not on the Approved Drug List

If a prescribed drug is not on CalOptima’s Approved Drug List, it must get approved first by CalOptima. Your doctor or pharmacy must use a Prior Authorization request form. The pharmacy and your doctor work together to send it to CalOptima for review. All CalOptima network pharmacies and doctors have this form.

You can also ask us for approval. Call Customer Service or fill out the Online Drug Prior Authorization Request form (below). For details about pre-approvals, see your Member Handbook.

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Online Drug Prior Authorization Request Form Your doctor must give you a prescription before you can fill out this form. It cannot be completed if you do not have a prescription from your doctor.

Other Important Pharmacy Information

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Changes to the Approved Drug List We review the Approved Drug List every 3 months. You can read summaries of the changes. Please talk with your doctor about changes to the Approved Drug List that may affect you.

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Drug Recalls and Withdrawals We want you to know when a drug is recalled or removed from the market. Talk with your doctor about any details on drug recalls and withdrawals that may affect you.

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MedImpact Drug Tools We have teamed up with MedImpact so that you can have access to a tool to help you. Create a MedImpact account to see all your drugs covered by CalOptima. You can also see if there is a generic or generic option for your drug. It lists if the drug you are taking may interact with other drugs. You can find out if there are side effects.

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