More than 850,000 people in San Diego County rely on Medi-Cal, California’s Medicaid program, and starting this year, some pharmacy visits may look different.
Several medications and over-the-counter products now require doctor approval, and some are no longer covered. At-home COVID-19 tests now need prior authorization, although children under 21 may still get them with a pediatric prescription. Approvals are limited to four tests per month, and each request must be approved separately.
Adult combination multivitamins are no longer covered, and single vitamins and dry-eye drops may require doctor approval before Medi-Cal will pay for them. Allergy medications are limited to generic versions, and popular weight-loss drugs, including GLP-1 medications like Wegovy, are no longer covered when prescribed solely for weight loss. Some remain covered for diabetes treatment.
The California Department of Health Care Services said the changes are meant to help control rising drug costs. But research shows that prior authorization requirements can be confusing and may lead to longer waits, delayed care, or unexpected out-of-pocket costs.
Before heading to the pharmacy, check whether a medication or over-the-counter item now needs prior approval and ask about generic or lower-cost alternatives. Research shows that a few questions ahead of time can help avoid surprises and extra costs at the counter.
