Covered Drug Lists

The PHC 2022 Medical Drug Benefit:

Medications which are injected, applied, inhaled, or otherwise administed by a medical practioner or delegate in a medical/dental/podiatry setting (such as, but not limited to, physician offices, clinics, hospitals, or dialysis centers).

PHC with direction from the Department of Health Care Services (DHCS/State Medi-Cal), the Pharmacy & Therapeutics (P&T) Committeem and the Physician Advisory Committee (PAC), maintains a covered drug list for its Medi-Cal line of business to be used by medical providers when directly administering pharmacologic treatment to members. Coverage requirements are subject to change. Please refer to quarterly P & T changes and to the Important Provider Notices updates for updated medical drug coverage information (links provided below). 

PHC covers the same HCPCS drug codes that State Medi-Cal includes on the Medi-Cal Injections: Code List; however, PHC billing & TAR requirements may differ from the State.