Separate pharmacy-benefit requests from drugs billed under the medical benefit. The PBM and the insurer may use different contacts.
pharmacy prior auth
Medi-Cal — physician-administered drug authorization fax
Official page read
Phone
No phone listed for this route
Fax
657-900-1649
Published hours
Not published in this record
Product, plan and location
medicaid California
Mailing address
Not researched for this route
Medical-benefit physician-administered drugs only. September 2026 manual section I2 directs the completed authorization form here; this is separate from retail Medi-Cal Rx and OneCare Part D intake.
Current provider Pharmacy page’s general CalOptima Health Pharmacy Program information contact. Specific drug authorization and appeal destinations are listed separately.
Current provider Pharmacy page links this form; use the OneCare Part D row. Phone is corroborated in current manual section I5. Appeals use the separately listed appeal fax.
For pharmacy personnel only. The currently linked OneCare support sheet is revised January 2025; current September 2026 manual I5 independently confirms the pharmacy PA telephone. Older conflicting B1 table numbers are not used.
Mailing addressCalOptima Health OneCare Complete (HMO D-SNP), a Medicare Medi-Cal Plan, 505 City Parkway West, Orange, CA 92868
Medicare drug coverage determination form and supporting information.
Form currently linked from the 2026 OneCare Pharmacy page; form code H5433_25IRPD039_C. TTY 711. Member, prescriber or authorized representative may use the form; representation requirements remain on the source.
Wait time: not establishedBest time from caller reports: not established. Published hours are not a wait forecast.
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Separate pharmacy-benefit requests from drugs billed under the medical benefit. The PBM and the insurer may use different contacts.
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PBM name and the pharmacy identifiers on the card
Drug, formulation and prescription information
Prescriber details and previous review reference
Questions to resolve
Is this processed under the medical or pharmacy benefit?
What is the correct review and submission channel?
Is there a separate specialty pharmacy or appeal team?
This is a general administrative checklist, not payer policy or advice about a particular patient. Confirm the current plan instructions.
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