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Home Healthcareplans Cal MediConnect Complaints, Grievances & Appeals

Complaints, Grievances & Appeals

Complaints, Grievances & Appeals

Pharmacy (Part D)

Your benefits as a member of our plan include coverage for many prescription drugs. Most of these drugs are “Part D drugs.” There are a few drugs that Medicare Part D does not cover but that Medi-Cal may cover. This section only applies to Part D drug appeals. The List of Covered Drugs (Drug List), includes some drugs with an asterisk (*). These drugs are not Part D drugs. For appeals about drugs with an asterisk (*) symbol follow the process in Complaints, Grievances & Appeals - Medical Care.

If you need help, please call Customer Service at 1-877-723-4795, Monday through Friday, 8 a.m. to 8 p.m. TTY/TDD users should call 1-800-735-2929 or 711. You can also get help or information from the Cal MediConnect Ombuds Program by calling 1-855-501-3077 or by visiting their website at www.healthconsumer.org.

For more information on Appeals and Grievances for Part D drugs, see Chapter 9, Section 6 in your SCFHP Member Handbook.

Do you need a drug that isn’t on our Drug List or need us to waive a rule or restriction on a drug we cover? OR

  • Do you want to ask us to pay you back for a drug you already got and paid for?
  • Have we already told you that we will not cover or pay for a drug in the way that you want it to be covered or paid for?

You can make an appeal. This means you are asking us to reconsider. See below for the process to make an appeal.

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