Enjoy Your Medicare Part D Medicines With CalOptima Health OneCare (HMO D-SNP)
With CalOptima Health OneCare (HMO D-SNP), the costs of your Medicare Part D medicines stay low, so your health stays on track. Our full list of medicines (or “formulary”) is crafted to meet your health care needs. With no or a very low copay from you, we’ll cover the rest of the cost of your medicines as long as:
- The medicine is medically necessary
- The prescription is filled at a network pharmacy
- Other plan rules are followed
Some of your medicines might need to be approved before you can get them (called “prior authorization”). You might also need to do “step therapy,” or try certain medicines to treat your condition before we cover another medicine for it. These steps help make sure the medicine you get is the best fit for your health needs.
See the List of Medicines We Cover
Our OneCare Complete and OneCare Flex Plus options each have their own formularies with all the medicines you need as well as clear guidelines for prior authorization and step therapy:
View Hundreds of Items Available to You Through Our OTC Network
Our catalogue of hundreds of over-the-counter (OTC) items allows you to choose the ones you need to be mailed to your home.
Order your OTC items in 3 easy ways
Online
Visit andmorehealth.com/onecare.*
* By visiting
andmorehealth.com/onecare, you will be leaving the official CalOptima Health website. The policies that apply to our website might not be the same as the terms of use for other websites. We don’t operate or control the linked website and are not responsible for its operation or content.
Mobile App
Download the OTC-Anywhere mobile application.**
** Available for Apple and Android mobile phones. There is no charge to download or use the app. Internet access is required. Data rates may apply.
Phone
Call 1-855-299-5410 (TTY 711).
Learn About Your Medicines, So You Can Make the Right Choices
The MedImpact Rx Portal gives you real-time info about your drug coverage, so you can compare prices and make the choices for you
Find a Pharmacy Near You
Our pharmacy search tool helps you find a location near you, so you can fill your prescriptions quickly and easily.
Take Part in Medication Therapy Management
Our Medication Therapy Management (MTM) Program can help you if you’re at high risk of having adverse effects from the medicines you take as a OneCare member.
See Important Info and Forms About Your Pharmacy Benefits
What to do if you’re taking medicines that aren’t on our formulary
As a new OneCare member, you might be taking medicines that aren’t on our formulary or have some restrictions. Talk to your primary care provider (PCP) about if you can switch to a medicine we cover or if you can get an exception. If you’re a current member and your PCP prescribes a drug we don’t cover, you can also ask for an exception.
Where to go to learn more about the transition process for new members
See our Medication Transition Policy for new members. It tells you how to get a temporary supply of your medicines that might not be on our formulary. It also lists medicines on our formulary that need prior authorization or have other restrictions.
How to ask for a prior authorization or an exception
Use our Request for Medicare Prescription Drug Coverage Determination form.
Request for Medicare Prescription Drug Coverage Determination form (OneCare Complete)
Request for Medicare Prescription Drug Coverage Determination form (OneCare Flex Plus)
How to appeal a denial of your Medicare prescription medicine
Use our Request for Redetermination of Medicare Prescription Drug Denial form.
Request for Redetermination of Medicare Prescription Drug Denial form (OneCare Complete)
Request for Redetermination of Medicare Prescription Drug Denial form (OneCare Flex Plus)
How to seek repayment for a medicine you paid out of pocket for
Use our Prescription Drugs Payment Request form.
OneCare Flex Plus 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.
This payment option might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs. Read the fact sheet for more information, such as:
- What programs can help lower your drug costs?
- Examples of how a monthly bill is calculated.
- How to decide if this program helps you.
- How much does it cost and what happens after you sign up?
- How and why to pay your bill.
You can sign up 3 ways
- By Phone: Call 1-877 -412-2734 (TTY: 711)
- By Mail: Download the printable Participation Request form
- Online: Visit https://m3p.caloptima.org*
*By clicking the link to https://m3p.caloptima.org you will be leaving the official CalOptima Health website. The policies that apply to the official CalOptima Health website may not be the same as the terms of use for other websites. CalOptima Health does not operate nor control the linked website and is not responsible for its operation or content.
Need more help?
Call CalOptima Health OneCare Customer Service 24 hours a day, 7 days a week at 1-877-412-2734 (TTY: 711).
- If you need help to decide if you should participate, or if you need to pick up a prescription urgently, call us to discuss your options.
- To leave the Medicare Prescription Payment Plan, call us to make your request.
- To file a complaint, call us or complete the Member Request, Appeal or Complaint form.
For more information about this payment option, download the Medicare Prescription Payment Plan fact sheet or visit www.medicare.gov/prescription-payment-plan.
Access Helpful Resources
Find a Doctor Near You
Search our network to find a trusted provider that meets your health care needs.
Learn About Advance Care Planning
Understand how advance care planning helps you make informed decisions about your health care.
Explore OneCare Benefits
See the benefits and services our OneCare program offers.
See Our Medication Therapy Management (MTM) Program
Access the tools you need to get the most from your medicines