OneCare (HMO SNP)

Pharmacy Program

Your pharmacy and medication benefits

Medicare Part D coverage is a federal program that helps pay for prescription medication. A formulary is a list of drugs covered by OneCare (HMO SNP). Under OneCare, your pharmacy benefits are covered with small co-payments. After you pay your co-payment, we will pay for drugs listed in our formulary if:

  • The drug is medically necessary
  • The prescription is filled at a network pharmacy
  • Other plan rules are followed

Some medications require approval before you can receive them. This is called “prior authorization.” In some cases, you must first try certain drugs to treat your medical condition before we will cover another drug for that condition. This is called “step therapy.”

Arrow Pointing Right Icon

2022 OneCare list of covered drugs (formulary) This includes criteria for prior authorization. It also has criteria for step therapy.

Mortal Pestle Icon

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

Other Important Pharmacy Information

Prescription drug transition and exceptions

New members may be taking drugs not on our formulary or subject to certain restrictions. You should talk to your primary care provider (PCP) to decide if you can switch to an appropriate drug we cover or request an exception. Current members can ask for an exception if your PCP prescribes a drug not covered.

Document with arrow pointing down icon

Medicare prescription drug transition policy Download PDF Icon This is CalOptima’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.

Document with arrow pointing down icon

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

Document with arrow pointing down icon

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

Document with arrow pointing down icon

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

Arrow Pointing Right Icon

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

Document with arrow pointing down icon

2022 Low-Income Subsidy Policy Download PDF Icon View the monthly plan premium for people who get extra help from Medicare to help pay for prescription drugs.

Contact Us
Visit Us
  • We are continuing to serve our members through our Customer Service phone numbers, as we adhere to guidelines to reduce the possibility of COVID-19 transmission. Our buildings are closed to visitors.

  • We speak your language
    Request interpreter services
New OneCare Members

To file a complaint with Medicare, click on the following link to complete a complaint form on the Medicare website: Medicare Complaint Form.

H5433_22WEB001_2022_A (Accepted 9/25/2021)


Materials available on this website in PDF format may require the free Adobe Reader to view. To download Adobe Reader for free from the Adobe website, click here.

Download the free Adobe Reader.