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
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: