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. For more information about medication coverage, please visit the Medi-Cal Rx website. 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 / Preferred Drug List (PDL)

• CCHP Commercial Plan (Plans A, B, A2, IHSS A-2) Formulary (or view as a pdf)
• Basic Health Care Formulary (or view as a pdf)

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:

• Prior Authorization Request (PA) Form (PDF).
  • PA Form (Online)
• Medication Prior Authorization Request (PA) form
• Request for Formulary Review 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

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