CalOptima has a list of medications that are covered (paid for) by CalOptima. This list is called the Approved Drug List or Drug Formulary. CalOptima pays for medications on this list when they are filled at one of CalOptima’s network pharmacies. You are not responsible for drug costs. To find a pharmacy, use the online Pharmacy Search Tool or read the CalOptima Pharmacy Directory in your member packet.
CalOptima’s Approved Drug List includes all covered medications listed by generic name or brand name (if there is one). Other medications may be covered with prior authorization from CalOptima. You are not promised a medication because it is on the Approved Drug List. Your provider will choose the best medication for your medical condition. All prescription drugs must be filled at a CalOptima network pharmacy. For more details about pharmacy services, see your Member Handbook.
If a medicine you need is not on CalOptima’s Approved Drug List, your doctor or pharmacy must ask CalOptima for approval. The approval request form is called a Prior Authorization (PA) Request form. The pharmacy and your doctor work together to submit it to CalOptima. All CalOptima network pharmacies and doctors have this form. Your doctor or pharmacy can fill out the form and send it to CalOptima for review.
You can also ask us directly, by calling Customer Service or filling out the Online Drug Prior Authorization Request form. When you complete and submit this form, CalOptima will work with your doctor to review your request. For more information, see your Member Handbook.
At CalOptima, we care about your health. We have teamed up with MedImpact so that you can have access to a tool to help you:
To use this tool, you need to click on the link below to go to the MedImpact website. To create a MedImpact account, please create a username and password.
If you have questions or need help with the MedImpact drug tool, please call the CalOptima Customer Service department at 1-714-246-8500 or toll-free at 1-888-587-8088, 24 hours a day, 7 days a week. TDD/TTY users can call toll-free at 1-800-735-2929. We have staff who speak your language.
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