Medication Formulary and Prior Authorization Request
- LACDMH Formulary
- LACDMH Prior Authorization (PA) Request Form (last updated 10/2019)
for Non-Formulary and Restricted Formulary Medications
Medication Access Programs
- Patient Assistance Programs (PAPs)
Clients may be eligible to receive medications at $0 through drug manufacturers’ Patient Assistance Programs (PAPs). Click here to search eligible medications
- Prescription Drug Coverage through LACDMH-Magellan
Eligibility Criteria
– Client is uninsured (i.e. has no active Medi-Cal, Medicare Part D, or other third-party prescription drug coverage) AND
– Client has at least 1 open episode in AVATAR AND
– If the most recent episode was opened > 3 months ago, client has received documented LACDMH service(s) within the last 3 months
If a client meets above criteria, either client, prescriber, prescriber’s staff, or retail pharmacy staff, may contact LACDMH-Magellan’s Customer Call Center at 800-424-6811 to obtain or renew a Magellan ID number for client. Network retail pharmacies will need the following information to process prescription drug claims for client.
Magellan ID# __________
RxBIN: 016523
RxPCN: 52268989
RxGRP: LACOUNTY
- Medicare Copay Assistance