Pharmacy Benefits

Community Health Group manages your pharmacy benefit that includes drug coverage. We help you and your doctor find a pharmacy in our network where you can get your medication.

Beginning January 1, 2021 Pharmacy Benefits

Pharmacy benefits will be managed directly through Medi-Cal Rx. If you have Medi-Cal Rx general questions, contact the Medi-Cal Member Help Line at 1-800-541-5555 or TTY 1-800-430-7077, Monday thru Friday, 8am to 5pm.

To find out more information, call CHG's 24/7 Member Services Department at 1-800-224-7766.

What is a formulary?

A formulary is a list of preferred drugs covered by Community Health Group (CHG).
You can review our formulary to find covered drugs by generic or brand name or view all drugs within a category.

Generic Drugs

Community Health Group requires pharmacies to give members generic drugs if they are available.
If you and your doctor believe that it is medically necessary for you to have a brand name drug, your doctor will submit a Drug Prior Authorization request form (PA).

Drug Prior Authorization Request

Some drugs require a prior authorization(PA) to explain to CHG why a specific medication or a certain amount of a medication is needed. Once CHG receives the form, we review the information to determine whether the request can be approved. Then we will send you and your doctor a letter with our decision.

We may require a PA if:

  • There is a generic drug available
  • The drug can be misused/abused
  • There are other drugs that must be tried first
  • The drug has a list of rules that must be met in order to use it 

Changes to Drug Coverage (Formulary) 

If you would like to see what changes have been made to the formulary, please click the link(s) below.

Drugs excluded from coverage from the Medi-Cal program include those that treat

  • Sexual Dysfunction
  • Cosmetic issues 

Find a Pharmacy

Search by pharmacy name, health plan, or location to find the nearest pharmacy to you.