Pharmacy Services

formularydownload1CenCal Health Pharmacy Services provides a comprehensive pharmacy benefit that includes formulary management, a robust pharmacy network, and quality customer service. Our pharmacy network spans both Santa Barbara and San Luis Obispo Counties providing our members with convenient pharmacy locations.

Pharmacy Benefit Manager

CenCal Health has contracted with MedImpact as its Pharmacy Benefit Manager (PBM) to assist in the administration of our pharmacy benefit.

medimpact

epocrates2MedImpact provides: 

  • Claims processing
  • Pharmacy network management
  • Prior authorizations
  • Customer service
  • Drug utilization management services

formsdownloadCenCal Health Pharmacy Team shall oversee MedImpact’s administrative and daily operational role. To contact MedImpact, call: (800) 788-2949.


Our Promise: Our Pharmacy Team is committed to providing consistent, compassionate, local support.

pharmacy news

Formulary Update: Preferred Alogliptin Products

Effective October 1, 2016, alogliptin products such as generic Nesina, Kazano and Oseni will be the preferred DPP-4 inhibitors on the CenCal Health Formulary. All other DPP-4 inhibitors will be removed from the CenCal Health formulary and a Medication Request Form (MRF) will be required. Januvia, Onglyza, Tradjenta, Janumet, Janumet XR, Jentadueto and Kombiglyze XR will no longer be formulary agents. 

In efforts to minimize any disruption to CenCal Health providers and members during this change, beginning August 1, 2016 providers who have members taking any of the DPP-4 inhibitors will receive a Prescription Change Form via a fax requesting providers to authorize a new prescription to CenCal Health's preferred alogliptin DPP-4 inhibitors. The form will serve as a valid order to begin dispensing the new medication with the next routine prescription fill. 

If the Prescription Change Form is not completed and faxed to MedImpact by October 1, 2016, a MRF will need to be submitted for medical necessity for all non-formulary DPP-4 inhibitors. 

For more information, please contact CenCal Health's Pharmacy Department at 805. 562.1080.

What are Carve-Out Drugs?

Carve-Out agents are medications in specific therapeutic classes that are not included in CenCal Health's scope of coverage. These agents are covered (or can be obtained with a TAR) from the State Medi-Cal Fee-For-Service Program. CenCal Health is not financially responsible for these agents and all claims (including secondary copays) must be submitted and reimbursed through State Medi_Cal. 

CenCal Health's Carve-Out List is updated at least quarterly. CenCal Health Carve-Out List 

Pharmacy Benefit Reminder: Diabetic Meters & Supplies

Abbott Diabetes Care, the manufacturer of the FreeStyle Freedom®, FreeStyle Lite® and Precision Xtra® diabetes testing meters and strips, are the preferred diabetic vendor through CenCal Health's Formulary for all programs. To receive your meter contact Abbott Diabetes Care. For questions regarding this program you may contact the Pharmacy Services Department at (805) 562-1080.

  



Formulary Updates

Formulary Updates March-April 2016

CenCal Health has made several changes to our Formulary based on clinical review, provider interest, cost and utilization analysis. 

All of the changes represent development and growth of our current Formulary thus giving more choices to the prescribing physician. The changes are represented in summary on the chart below.

Drug
Class Formulary Status Restriction/Limits  Implementation Date 
Formulary Additions 
Entresto® Cardiovascular Disease
Formulary: PA Required Restriction: Prior Authorization Required 3/1/2016
Corlanor® Cardiovascular Disease Formulary: PA Required Restriction: Prior Authorization Required 3/1/2016
Omeprazole 40mg Upper Gastrointestinal Disorders Formulary: Quantity Restriction Restriction: Quantity limit of 30 capsules per 30 days 3/1/2016
Spiriva Respimat® 1.25mcg COPD Formulary
3/1/2016
Priftin® Infectious Disease Formulary   3/1/2016
Synjardy® Diabetes Formulary: Quantity Restriction Restriction: Quantity limit of 60 tablets per 30 days 4/1/2016
Quillichew ER® Behavioral Health Formulary: Quantity & Age Restriction Restriction: 20mg, limit of 30 per month & up to a 90 days supply

30mg, limit of 60 per month & up to a 90 day supply

40mg, limit of 30 per month & up to a 90 day supply

All strengths have an age restriction of 18 years or less
4/1/2016
 Formulary Changes
Prevacid ODT®

Upper Gastrointestinal Disorders Non-Formulary   3/1/2016
Lansoprazole  Upper Gastrointestinal Disorders Formulary Restriction: Step Therapy-double step 6 week trial of both Omeprazole and Pantoprazole 3/1/2016
Pantoprazole Upper Gastrointestinal Disorders Formulary Removed Step Therapy 3/1/2016
 Penicillamine    Non-Formulary   3/1/2016

specialty pharmacy

Specialty medications are processed uniquely, require special handling, and entail personalized medication management. CenCal Health has contracted exclusively with Diplomat and Accredo Specialty Pharmacy to provide specialty medications for our members. Learn more about specialty medications and review our Specialty Drug List.

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