Preferred Drug List

Effective 1/01/2022, all administrative services related to Medi-Cal pharmacy benefits billed on pharmacy claims from the existing Medi-Cal Fee-for-Service (FFS) or Managed Care Plan (MCP) intermediaries have transitioned to Medi-Cal Rx. Please see the Medi-Cal Rx web page at medi-calrx.dhcs.ca.gov/home/ for more information. For more specific information about medication coverage, please visit medi-calrx.dhcs.ca.gov/home/cdl. For customer service assistance, call the Medi-Cal Rx Customer Service Center at 1-800-977-2273, 24 hours a day, 7 days a week, 365 days per year

Search Online Formulary

• CCHP Plan A, Plan B, Plan A2, IHSS Plan A-2 Formulary
• Basic Health Care Formulary

Contra Costa Health Plan has adopted a Preferred Drug List (PDL). Starting July 15, 2002 all new prescriptions for CCHP patients (except permanent County employees) must be taken from our PDL formulary or be accompanied by a Medication Prior Authorization Request (PA) form. Both of these documents are available for download in PDF format:

• CCHP Commercial Preferred Drug List (PDL)
• CCHP BHC Preferred Drug List (PDL)
• Prior Authorization Request (PA) Form | Word
  — PA Form Online »
• Medication Prior Authorization Request (PA) form
• Synagis Prior Authorization Request form
• Direct Member Reimbursement Form

The Preferred Drug List is the prescription drug formulary for the Contra Costa Health Plan.

Medi-Cal recipients receive prescribed medications at no cost.

Medication PA Criteria

Below is the medication prior authorization criteria for Contra Costa Health Plan:

• CCHP Pharmacy PA criteria