Pharmacy

Pharmacy Program at California Health & Wellness is to provide access to pharmacy services to our members, and to ensure that these services are a covered benefit, medically necessary, appropriate to the member’s condition, rendered in the appropriate setting, and meet professionally recognized standards of pharmacy care.

Preferred Drug List

California Health & Wellness has created a Preferred Drug List (PDL). The PDL is continually evaluated by a committee of practicing physicians and pharmacists to ensure appropriate and cost-effective use of medications without compromising the quality of care. Click on the link below to see the full list.

Epocrates
Preferred Drug List (PDL)
Provider Quick Reference Guide
Pharmacy PDL Change Request Form

Medication Prior Authorization Requests

Some medications require prior authorization from California Health & Wellness in order for reimbursement to be issued to the provider. Medications requiring prior authorization include:

  • Medications not listed on the Preferred Drug List (PDL)
  • Medications listed on the PDL with restrictions or limitations, such as:
  • Step Therapy
  • Quantity Limit
  • Age Limit

Use the form below when submitting a prior authorization request for medications:

Prescription Drug Prior Authorization Request Form (No. 61-211)

Please note the contact information differs based on the type of prior authorization request being made:

Self-Administered Non-Specialty Medications  
US Script
US Script, California Health & Wellness Pharmacy Benefit
Manager, processes pharmacy claims and administers
the prior authorization process for self-administered
(i.e. oral, self-injectable, topical, ophthalmic) drugs.
Fax: 1-866-399-0929
Phone: 1-877-277-0413
Self-Administered Specialty Medications  
AcariaHealth
AcariaHealth, California Health & Wellness preferred specialty
pharmacy vendor, can supply a number of specialty
medications. Requests for specialty medications are
screened by AcariaHealth prior to review by US Script.
Fax: 1-855-217-0926
Phone: 1-855-535-1815
Physician-Administered Specialty Medications  
California Health & Wellness Pharmacy Department
The California Health & Wellness Pharmacy Department
handles prior authorization requests for medications
that will be administered by a provider
 (i.e.
biopharmacy, home health, outpatient, injectable or
infusible medications).
Fax: 1-877-259-6961
Phone: 1-877-658-0305

Find a Provider

To find a pharmacy that is in the California Health & Wellness network you can use the Find a Provider tool. Choose Other and type the name of the pharmacy or select the pharmacy type in the Select Specialty area. Only those pharmacies in the California Health & Wellness network are listed.