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.
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.
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
Drugs excluded from coverage from the Medi-Cal program include those that treat
- Sexual Dysfunction
- Cosmetic issues
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