Pharmacy and prescription drugs
Your benefits include a wide range of prescription and over-the-counter (OTC) medicines. You can even have your medicines delivered to your home. We work with IngenioRx to provide these pharmacy benefits. Medi-Cal members do not have a copay or deductible for prescription drugs.
Find a pharmacy
To find a pharmacy near you, use our pharmacy locator tool. Medi-Cal members will need to log in to their secure account to use the tool.Find a Medi-Cal pharmacyFind a MRMIP pharmacy
Fill a prescription
Starting October 1, 2019, Rite Aid has returned to your pharmacy network. You now have even more pharmacy choices available.
Bring your member ID and prescription to a plan pharmacy. A doctor can also call in the prescription for you. MRMIP members have the option to use any pharmacy, but costs are much lower if you use a plan pharmacy.
It’s good to use the same pharmacy each time you fill a prescription. This way, your pharmacist will know about problems that may happen when you’re taking more than one prescription. If you use another pharmacy, you should tell the pharmacist about all medicines you or your child are taking.
Have your medicines mailed to you
We make getting your prescriptions filled as convenient as possible. You can log in to your account and manage your prescriptions filled through home delivery. With your secure online account, you can:
- Order refills.
- Track your shipments.
- Get notifications.
Prescription Drug Home Delivery Form
You can get many prescription drugs shipped directly to your home through IngenioRx Home Delivery. Use this form to set up home delivery on your prescription.
Copays are a set dollar amount you pay for a covered service, like getting a prescription filled.
There are no copays when you fill your prescription at a plan pharmacy.
Major Risk Medical Insurance Plan (MRMIP) members
There is a $10 copay for generic drugs and a $35 copay for brand-name drugs (up to a 100-day supply) when you fill your prescription at a plan pharmacy.
Drug coverage information
Your benefits include a wide range of prescription drugs. Anthem also covers many over-the-counter (OTC) medicines.
The formulary is a list of all brand-name and generic drugs available in your plan. All drugs on the formulary are covered, but many require preapproval before the prescription can be filled.
Find your medicine
Do you want to look up your medicine and find out if it is covered in your plan? It’s easy when you use our search tool. This tool will help you learn about any limitations or restrictions for any particular drug.
You can search for your drug by:
- Typing the name (at least first three letters) of the drug in the search box.
- Using the A-Z list to search by the first letter of your drug.
- Clicking the therapeutic class of the drug.
You can also view and print the whole drug list (formulary).
The formulary is a list of all brand-name and generic drugs available in your plan. All drugs on the formulary are covered, but some drugs may require preapproval before the prescription can be filled. Our Pharmacy and Therapeutics (P&T) Committee reviews and recommends what drugs should be in the formulary. They choose the medications for our drug list based on things like how safe the drug is, how well it works and how much it costs.
Don’t see it listed?
If you don’t see your medicine listed in the formulary, you may ask for an exception at email@example.com. You’ll be asked to supply a reason why it should be covered, such as an allergic reaction to a drug, etc.
Prior authorizations (preapprovals)
Some medicines need a preapproval, or an “OK,” from Anthem before your doctor can prescribe them. The preapproval process helps us make sure that you’re taking medications safely and correctly.
Here are some reasons that preapproval may be needed:
- There is a generic or pharmacy alternative drug available.
- The drug could be misused or abused.
- There are other drugs that should be tried first.
- The drug has a high side effect potential.
- The drug is prescribed at a higher dosage than recommended.
- There is additional information needed about your condition so we can match it to the FDA approval of the drug and/or studies of effectiveness.
For medicines that need preapproval, your provider will need to contact us. Anthem will review the request and give a decision within 24 hours. If you need your medicine right away, you may be able to get a 72-hour supply while you wait.
If you misplace your medicine or it is stolen, contact your provider. They will work with the pharmacy and Anthem to review your case and replace the medicines as needed.
If you have any questions about your pharmacy benefit, call Pharmacy Member Services 24 hours a day, seven days a week at 1-833-205-6004 (TTY 711) for Medi-Cal members outside L.A. County, 1-833-232-1712 (TTY 711) for Medi-Cal members in L.A. County, or 1-833-214-3605 (TTY 711) for MRMIP members.
Prescription Drug Reimbursement Form
If you had to pay for a medicine that is covered under your plan, you may submit a request for reimbursement form. Reimbursements do not apply for MRMIP copays.
For medicines purchased before October 1, 2019:
For medicines purchased on or after October 1, 2019:
Prescription Drug Home Delivery Form
IngenioRx Notice of Privacy Practices
Get your specialty medications
If you have a complex or chronic health condition that requires special medicine, we can help. We partner with IngenioRx Specialty Pharmacy and other pharmacies to meet all your specialty medication needs.Learn about specialty pharmacy