On Saturday, January 1, 2022, the Department of Health Care Services (DHCS) changed how the Medi-Cal pharmacy benefit is administered and the new pharmacy benefit contractor, Prime Therapeutics, provides services and support. For more information and provider resources, please click here.

To view the Medi-Cal Rx Contract Drug List (CDL) and Covered Products List, please visit: https://medi-calrx.dhcs.ca.gov/home/cdl/

Providers can view and search through our formulary using the links below. The Alliance Medication Formulary is a list of medications covered by the Alliance to meet your patient’s needs. This formulary applies to Alliance Group Care only.

To search the Alliance Medication formulary, please click here.

Formulary Updates

The Alliance Pharmacy & Therapeutics (P&T) Committee meets quarterly to review the medication formulary, medication utilization patterns, and to establish and/or update the formulary, guidelines, protocols, programs, and procedures that help ensure high quality, cost-effective medication therapy.

Providers can submit a Formulary Review Request Form to the Alliance Pharmacy & Therapeutics (P&T) Committee for their consideration for review of a medication.

To view Alliance Formulary updates, please click here.

Formulary Management Procedures

Certain restrictions and limits may apply to the medication on the Alliance’s Medication Formulary.

Age Limits

When there is a clear justification for certain age groups, the Alliance will apply age limits.

If a medication is required outside of the age limit, a Prescription Drug Prior Authorization (PA) Request Form, along with documentation of an existing medical need, must be submitted for consideration. Procedures and timeframes will follow our prescription drug PA process.

Generic Substitution

The Alliance has a mandatory generic program. The intent of this program is to promote utilization of appropriate generic alternatives, when medically appropriate.

If a brand name product is necessary in lieu of an approved generic medication due to a documented medical need, a Prescription Drug Prior Authorization (PA) Request Form must be submitted. Procedures and timeframes will follow our PA process.

Quantity Limits

A quantity limit establishes the maximum amount of medication that the Alliance will cover within a defined period of time.

If a member has a medical condition that requires a quantity medication that exceeds our limit, a Prescription Drug Prior Authorization (PA) Request Form, along with documentation of an existing medical need, must be submitted for consideration. Procedures and timeframes will follow our prescription drug PA process.

Step Therapy

The Alliance uses Step Therapy to promote cost-effective pharmaceutical management when there are multiple effective medications available to treat a medical condition.

Medications that have a Step Therapy requirement will require one (1) or more prerequisite first step medication(s) to be tried before progressing to a second step medication. When a prescription for a Step Therapy medication is filled at the dispensing pharmacy, the pharmacy benefits claims processor will search past claims for the first step medication.

A Step Therapy medication can be obtained without a prerequisite first step medication by submitting a Prescription Drug Prior Authorization (PA) Request Form, along with documentation of an existing medical need for consideration. Procedures and timeframes will follow our prescription drug PA process.

Therapeutic Interchange

The Alliance may use Therapeutic Interchange to promote rational pharmaceutical therapy when evidence suggests that outcomes can be improved by substituting a medication that is therapeutically equivalent but chemically different from the prescribed medication.

Therapeutic Interchange protocols are never automatic; a dispensing provider may not substitute a therapeutically equivalent alternative medication for the prescribed medication without the knowledge and authorization of the prescribing practitioner.