Pharmacy Program

2025 OneCare Complete list of covered drugs (formulary) This includes criteria for prior authorization. It also has criteria for step therapy.

2025 OneCare Flex Plus list of covered drugs (formulary) This includes criteria for prior authorization. It also has criteria for step therapy.

2024 OneCare list of covered drugs (formulary) This includes criteria for prior authorization. It also has criteria for step therapy.

2024 Over-the-Counter (OTC) Benefits Learn how to order OTC products online, by phone or by mail.

Pharmacy Benefit Tool For real time formulary and drug benefit coverage information, log in to the MedImpact Rx Portal. This tool will help you make informed drug choices and compare drug prices.

Find a Pharmacy Use the search tool to find a network pharmacy near you.

Medicare prescription drug transition policy  This is CalOptima Health’s transition process for enrollees. It tells you how to get a temporary supply of non-formulary Part D drugs during the transition period. It also lists formulary drugs that have prior authorization or other utilization management restrictions.

Request prescription drug coverage determination  Use this form to ask for prior authorization or an exception.

Request for redetermination of Medicare prescription drug denial  Use this form to ask for redetermination (appeal).

Prescription drug payment request  If you paid out-of-pocket, use this form to request payment.

Medicare Prescription Payment Plan The Medicare Prescription Payment Plan is a new payment option to help you manage your out-of-pocket Medicare Part D drug costs by spreading them across the calendar year (January-December). Participation is voluntary. There’s no cost to participate in the Medicare Prescription Payment Plan.

Medication therapy management This program gives you tools to get the most from your drugs. It can help you stay healthy.