Member Handbook - Los Angeles County Department of Health ...

Medi-Cal Member Handbook / Benefit Year 2006-2007What drugs are covered?You can get the following drugs and other itemswhen they are prescribed by your doctor and aremedically necessary:• Prescription drugs listed on the CommunityHealth Plan formulary• Prescription drugs you get from a pharmacynot in Community Health Plan’s networkwhen you have an emergency.• Non-prescription drugs or “over-the-counter”drugs (such as cough syrups, cough drops oraspirin) listed on the formulary• Diabetic supplies: insulin, insulin syringes,glucose test strips, lancets and lancet puncturedevices, pen delivery systems, blood glucosemonitors including monitors for the visuallyimpaired, ketone urine testing strips• FDA-approved birth control and birth controldevices, birth control pill, diaphragms, condomsand contraceptive jellies on theCommunity Health Plan formulary• Emergency contraception• EpiPens, Anakits and inhaler extender devicesWhat drugs are not covered?• Drugs from a non-network pharmacy, exceptdrugs needed because of an emergency or outof area care.• Non-formulary drugs, except with an okayfrom Community Health Plan.• Drugs that are experimental or investigationalin nature, except in certain cases of terminalillness. If you have been denied an experimentalor investigational drug, you have the rightto request an Independent Medical Review(IMR). This is talked about in “Complaints:What should I do if I am unhappy?” in thishandbook.• Cosmetic drugs, except as prescribed formedically necessary conditions.• Dietary or nutritional products, except whenmedically necessary or for the treatment ofPhenylketonuria.• Any injectable drug that is not medicallynecessary and not prescribed by a doctor.• Appetite suppressants, except as medicallynecessary for morbid obesity.• Compounded medications with formularyalternatives or those with no FDA-approvedindications.• Replacement of lost or destroyed drugs morethan two times each calendar year (from Januaryto December).Emergency contraceptionYou may get emergency contraceptive drugsfrom:• your doctor• a pharmacy with a prescription from yourdoctor• a pharmacy without a prescription if theyparticipate in the Pharmacy Access Programin your health plan’s network• a pharmacy not in your health plan’s networkif they participate in the Pharmacy AccessProgram. If this is the case, you will be askedto pay for the service. Your health plan willreimburse you for this cost.Call L.A. Care or Community Health Plan for alist of pharmacies that participate in the PharmacyAccess Program. You may also call your pharmacyand ask if they participate in the PharmacyAccess Program.23Community Health Plan Member Services Department toll-free 1-800-475-5550L.A. Care Health Plan Member Services Department toll-free 1-888-4LA-Care or 1-888-452-2273