Prescription Drugs and Pharmacy Benefits
If you need medications to treat your illness or condition, your doctor will give you a prescription. Once you choose a pharmacy, take your prescription to that pharmacy to get your medication. Your doctor may also send it to the pharmacy for you. Make sure the pharmacy knows about all of the medications you are taking and any allergies you have. If you have any questions about your prescription, make sure you ask the pharmacist.
If you are told that a medication is not covered by your insurance or if you are asked to pay for a medication, here is what to ask:
- If the pharmacy tells you the drug is not covered, ask the pharmacy staff why the drug is not covered.
- If the pharmacy says the drug has been denied, ask if the medication needs prior authorization from the Alliance or MediCal Rx. The pharmacy staff will need to let your doctor know to request prior authorization and include any needed medical information. Your prescription might get denied because it is not in our list of covered medications. You can find more information in our Filling Your Prescription section below.
- You can also call your doctor to ask if there is another drug that would be covered instead.
Always follow up with your doctor or the Alliance if you cannot get a medication that has been prescribed by your doctor. If you need help or have more questions, call Member Services.
Alliance policy and procedures
If you would like to see a copy of the Alliance pharmacy policy and procedures, please call Member Services.
Medi-Cal members
Your prescription drugs are covered by Medi-Cal Rx, not the Alliance. Medi-Cal Rx is the program that manages prescriptions for all Medi-Cal members in California.
For most Medi-Cal members, there is no cost for prescriptions.
Your doctor knows which medications are approved by Medi-Cal Rx, which need prior approval and how to get approval. The list of Medi-Cal Rx covered medications is called the Medi-Cal Rx Contract Drugs List. Sometimes, a drug is needed and is not on the Contract Drugs List. These drugs will need to be approved before they can be filled at the pharmacy. Medi-Cal Rx will review these requests. If you have questions about whether your medications are covered, talk to your doctor or pharmacist. If your doctor or pharmacist cannot answer your questions, call Medi-Cal Rx Customer Service at 800-977-2273 or visit the Medi-Cal Rx website.
Alliance Care IHSS Members
The Alliance covers prescription drugs for Alliance Care IHSS plan members. We contract with a company called MedImpact for pharmacy services. Once you choose a pharmacy, take your prescription to that pharmacy. Give the pharmacy your prescription with your Alliance ID card.
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