Pharmacy Services
CenCal Health is committed to providing consistent, compassionate, and local support to all CenCal Health providers and members.
CenCal Health’s Pharmacy Team is comprised of Pharmacist and Pharmacy Technician staff. Our Pharmacy Team is ready to assist our provider network and membership with pharmacy-related inquires and education.
Medi-Cal Rx Update: Pediatric Integration, effective January 31, 2025
- Now Active: Completion of Pediatric Integration of Members 21 Years of Age and Younger
- Two-Week Countdown: Completion of Pediatric Integration of Members 21 Years of Age and Younger
- 30-Day Countdown: Completion of Pediatric Integration of Members 21 Years of Age and Younger
- Coming Soon: Completion of Pediatric Integration of Members 21 Years of Age and Younger
- Now Active – Pediatric Integration for New Start Therapies and CCS Panel Authority
- Now Available: CCS Panel Authority Policy Exclusions on the Medi-Cal Rx Approved NDC List
- Update: Important Policy Adjustment for Pediatric Integration
- 30-Day Countdown: Pediatric Integration of Members 21 Years of Age and Younger
- Medi-Cal Rx Pediatric Integration - Frequently Asked Questions (FAQs)
Medi-Cal Rx: Medi-Cal Pharmacy Benefit
Effective January 1, 2022, CenCal Health’s Pharmacy benefit called Medi-Cal Rx is administered through DHCS and its vendor, Prime Therapeutics State Government Solutions LLC. Prime provides a comprehensive suite of administrative services as directed by DHCS, which includes claims management/adjudication, prior authorization, utilization management, and customer/support.
Medi-Cal Rx is responsible for administering the following when billed by a pharmacy on a pharmacy claim:
- Covered Outpatient Drugs, including Physician-Administered -Drugs (PADs)
- Medical Supplies
- Enteral Nutritional Products
Additional information regarding Medi-Cal Rx can be found in the “Medi-Cal Rx News” tab below and directly from the DHCS Medi-Cal Rx web site.
For additional assistance contact Medi-Cal Rx Customer Service at: (800) 977-2273
You may also want to visit the Medi-Cal Rx Communication page for any upcoming bulletins and news.
CenCal Health Pharmacy Services: Medical Pharmacy Management
CenCal Health and the Pharmacy Services Team will be responsible for a variety of activities including, but not limited to: oversight of clinical pharmacy adherence, Drug Utilization Review (DUR) and all utilization management associated with pharmacy services (Physician-Administered-Drug) billed on a medical and institutional claim. CenCal Health defines the utilization management of Physician-Administered-Drugs on the medical benefit as Medical Pharmacy Management.
Additional information and education resources for CenCal Health’s Medical Pharmacy Management Program can be found on our Medical Pharmacy Management page.
Respiratory syncytial virus (RSV) is recognized as one of the most common causes of childhood illness and is the most common cause of hospitalization in infants. It causes annual outbreaks of respiratory illnesses in all age groups, and usually starts in the fall and peaks in the winter in most regions in the United States. The CDC recommends RSV vaccination for all adults ages 75 and older and adults ages60-74 who are at increased risk of severe RSV. To protect infants from severe RSV, CDC recommends an RSV vaccine for pregnant people, or a monoclonal antibody given to the baby after birth.
For adults who need an RSV vaccine and have not yet received a dose, RSV vaccine can be administered at any time during the year, but the best time to vaccinate patients is in late summer and early fall before RSV usually starts to spread in the community. RSV vaccine is not an annual vaccine, meaning patients do not need a dose every RSV season. Studies are ongoing to determine whether (and if so, when) revaccination may be needed. There are three RSV vaccines licensed by the U.S. Food and Drug Administration for use in adults ages 60 and older in the United States and they are Arexvy, mResvia, and Abrysvo.
There are two safe and effective immunizations to prevent RSV lower respiratory tract infection in infants. Either a maternal vaccination (Abrysvo) given to mom during pregnancy, or a monoclonal antibody (Beyfortus) given to the baby is recommended, but administration of both is not needed to protect most infants.
Most RSV vaccines are a Medi-Cal benefit and can be covered through the CenCal Health medical benefit or Medi-Cal Rx pharmacy benefit. The exception is Beyfortus which is a covered under the Vaccines for Children (VFC) program and can only be obtained through VFC providers. Medi-Cal will reimburse VFC enrolled providers for VFC funded vaccines when administered for Medi-Cal members 18 years of age and younger for the following three different services:
- Vaccine Administration Fee
- Professional Dispensing Fee
- Pharmacist Services (consultation and assessment [vaccine initiation] fee)
Please reference the Vaccines For Children Program: Medi-Cal Reference Guide for further information.
If you have questions or need additional information, please contact CenCal Health Pharmacy Department at (805) 562-1080.
Medi-Cal Rx Updates:
Pursuant to the enacted 2025-26 State Budget, the Department of Health Care Services (DHCS) is implementing a series of Medi-Cal Rx policy updates over the coming months to reduce pharmacy spending, improve program integrity, and ensure continued, equitable access to quality pharmacy benefits and services. DHCS will provide notice with further details in advance of each of the following Medi-Cal Rx policy update implementation dates:
Effective November 1, 2025:
- The coordination of benefits (COB) claims submission process will be updated for Medicare.
Effective January 1, 2026:
- Over the counter (OTC) COVID-19 antigen tests will require a prior authorization (PA) request for all Medi-Cal members.
- Drugs used for weight loss and weight loss-related-indications will be excluded from Medi-Cal coverage for all Medi-Cal members.
- For members 21 years of age and older, Medi-Cal Rx coverage policies will be revised for select OTC products, including prenatal vitamins, multivitamin combinations, and single-ingredient vitamin products; first -and-second generation antihistamines; and dry eye products.
- Claims for select products that are paying due to continuation of care exceptions, as identified in the Medi-Cal Rx Contract Drug List (CDL) will no longer be covered benefits for all members.
- Specific non-covered drugs will now require use of a therapeutically alternative Medi-Cal Rx CDL drug, prior to being a paid benefit. Continuation of care will not apply.
Contact Information
You can call the Medi-Cal Rx Customer Service Center (CSC) at 1-800-977-2273, which is available 24 hours a day, 7 days a week, 365 days per year.
For other questions, email Medi-Cal Rx Education & Outreach at MediCalRxEducationOutreach@primetherapeutics.com
Pharmacy Locator Tool Enhancements
The Medi-Cal Rx Pharmacy Locator Tool allows users to search for Medi-Cal Rx participating pharmacies by location. The tool offers additional search filters and display options to allow users to filter their search results by services offered, hours of operation, accessibility accommodations, and more.
*Pharmacy information including hours, services offered, and languages spoken is reported by each pharmacy and is subject to change.
What Pharmacy Providers and Prescribers Need to Know
The Medi-Cal Rx Pharmacy Locator Tool has been enhanced to include additional search parameters and display additional pharmacy information.
Enhanced search and filter options include:
- Accepting New Patients
- Accessibility Accommodations
- Telehealth Available
Enhanced pharmacy details include:
- Pharmacy Website (if applicable)
- Languages Spoken
- Accessibility Accommodations
The Medi-Cal Rx Pharmacy Locator Tool is located on the Find a Pharmacy page on the Medi-Cal Rx Web Portal.
Contact Information
You can call the Medi-Cal Rx Customer Service Center (CSC) at 1-800-977-2272, which is available 24 hours a day, 7 days a week, 365 days per year.
Medi-Cal Rx Resources and Contracted Drug List (CDL)
Now Available: Medi-Cal Rx Enteral Nutrition Prior Authorization Request
Medi-Cal Rx Searchable Drug Lookup & Contracted Drug List
Medi-Cal Rx Contract Drug List
Find a Pharmacy Search Tool
Medi-Cal Rx Support Services
The following document will provide the processing information for Medi-Cal Rx (i.e. BIN, PCN & Group) and additional payer information.
Medi-Cal Rx Support Services and Key Payer Sheet Details
Pharmacies requesting additional operational claims support please contact:
Medi-Cal Rx Customer Service Center at: (800) 977-2273