As a Gold Coast Health Plan (GCHP) member, you most likely get the medicines your doctor prescribes at a pharmacy. Or you may get some medicines at your doctor's office or at the hospital. If your doctor decides that you need to get a medicine at your doctor's office or at the hospital such as an injection (shot) then the medicine is covered by GCHP's Medical Drug Benefit. The medicines that you get at a pharmacy are covered by Medi-Cal Rx, the state's pharmacy program.
GCHP-Covered Medications
GCHP reviews Treatment Authorization Requests submitted by your doctor and decides which medicines and how much is covered by the Medical Drug Benefit. You can find updates and changes to the Medical Drug Benefit on the GCHP website here. You can also find GCHP’s medicines that needs approval, also known as the Physician Administered Drug (PAD) list, and what is needed to cover your medicines. GCHP updates this information four times a year.
If you have any questions or want a copy of the PAD list and what GCHP needs to cover the medicines through this benefit, call GCHP’s Member Services Department at 1.888.301.1228, Monday through Friday, 8 a.m. to 5 p.m. (except holidays). Si usa TTY, llame al 711.
The state Department of Health Care Services (DHCS) Medi-Cal Managed Care and Mental Health Office of the Ombudsman helps resolve problems from a neutral standpoint and can connect you with the right person / department to help you with your problem. Their contact information is:
DHCS Medi-Cal Managed Care and Mental Health Office of the Ombudsman
- Call: 1.888.452.8609, Monday through Friday, 8 a.m. to 5 p.m. (except holidays)
- Email: MMCDOmbudsmanOffice@dhcs.ca.gov