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 free mail order service to fill prescriptions. The preferred mail order pharmacy for L.A. Care Medicare Plus members is Quality Drug Clinical Care (Quality Drug). The mail order pharmacy for L.A. Care Covered, L.A. Care Covered Direct, and Homecare Workers Health Care plan members is Postal Prescription Services (PPSRX). There is more information in the blue box below. We also have frequently asked questions about this service.
Please look at the 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 Medicare Plus
L.A. Care is providing members with free mail order services. The preferred mail order pharmacy for L.A. Care Medicare Plus members is Quality Drug Clinical Care (Quality Drug).
Members can get a 100-day supply 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)
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.
Quality Drug Form
Quality Drug Form (Spanish)
L.A. Care Covered/Direct & Homecare Workers Health Care Plan
L.A. Care is providing members with mail order services through Postal Prescription Services (PPSRX). This is a free service to L.A. Care Covered, L.A. Care Covered Direct, and Homecare Workers Health Care Plan members.
Members can get a 90-day supply 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 Postal Prescription Services at 1-800-552-6694 or log in to your Postal Prescription Services account to manage prescriptions, order refills, and review your prescription status here.
If the medication(s) has no refill(s) remaining, please call Postal Prescription Services at 1-800-552-6694 or request a refill online. If you prefer to mail in your prescription request to Postal Prescription Services, you can print out the form below.
Postal Prescription Services Form
Postal Prescription Services Form (Spanish)
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.
Prescription Management Safety Initiatives
Some L.A. Care members may be chosen to enroll in the Pharmacy Home Program. The Pharmacy Home Program will help members handle their controlled medications safely.
You may be chosen to enroll in this program if:
- You received prescriptions for controlled medications from three (3) or more providers.
- You filled prescriptions for controlled medications at three (3) or more pharmacies within the past 90-day period.
A Pharmacy Home is a pharmacy that works with L.A. Care where you will get all your prescriptions for controlled medications filled. If you are chosen to enroll in the program, L.A. Care will give you a written notice. You are able to choose one pharmacy that works with L.A. Care as your Pharmacy Home. If you do not choose a Pharmacy Home, L.A. Care will choose a pharmacy closest to you. In an emergency, you may get your prescriptions filled at another pharmacy. L.A. Care will let your doctor know when you are enrolled in the program.
L.A. Care will excuse you from the Pharmacy Home Program if:
- You are in hospice care, have sickle cell disease, or have cancer;
- Being in the Pharmacy Home Program causes you trouble in finding care or causes an unnecessary health risk;
- Other reasons will be considered on a case by case basis.
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.
October 2024 Formulary Updates
September 2024 Formulary Updates
February 2024 Formulary Updates
January 2024 Formulary Updates
January - December 2023 Formulary Updates
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.
If you need assistance with the Prior Authorization Request process, please contact L.A. Care Member Services, 1-888-839-9909 (TTY/TDD) 711.
Member cost share varies by plan. Please refer to your member handbook for specific cost share information.