Prescription Drug Program

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)
  • Hospitals
  • Ancillary

The following medications are covered under Health Net's Medi-Cal plan:

  • Medications administered while the member is hospitalized or in an emergency room
  • Medications administered in a provider’s office or infusion center billed through the medical benefit
  • Home infusion or other medication-related services billed through the medical benefit

The following medications are covered by the Medi-Cal Rx program

  • Self-administered and provider-administered medications listed on the Medi-Cal Rx Contract Drug List (CDL) and billed through a pharmacy
  • Self-administered and provider-administered medications not listed on the Medi-Cal Rx CDL billed through a pharmacy (prior authorization may be required)
  • Medications prescribed by a psychiatrist that are on the Medi-Cal Rx CDL and filled at a participating Medi-Cal Rx pharmacy
  • A 72-hour supply of a covered medication in a medical emergency.
  • Medical supplies, including personal home-use blood pressure monitors and blood pressure cuffs for use with personal, home blood pressure monitoring devices, and therapeutic continuous blood glucose monitors are a covered benefit under Medi-Cal Rx.

Medications for the treatment of AIDS and HIV are excluded from Health Net's coverage responsibilities and are covered under the DHCS Medi-Cal FFS program and Medi-Cal Rx. Refer to the discussion of carve-out medications in this section for more information.

Health Net Medi-Cal does not cover health care services for California Children's Services (CCS)-eligible conditions, but they are covered under the CCS program. Prescriptions written for children with CCS active conditions need to be written by a CCS-paneled provider and billed directly to CCS.

Due to the passage of federal legislation (HR 3971), where federal financial contribution has been discontinued for all medications used to treat sexual or erectile dysfunction, the state of California has decided to discontinue coverage of such medications under the Medi-Cal program, unless used to treat a condition other than sexual or erectile dysfunction.