IEHP DualChoice (HMO D-SNP) is a Health Plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. It is an organization made up of doctors, hospitals, pharmacies, providers of long-term services and supports, behavioral health providers, and other providers. It also has care coordinators and care teams to help you manage all your providers and services. They all work together to provide the care you need.

The goal is to improve care by integrating the following healthcare services:

• Medicare and Medi-Cal benefits
• Long-term care
• Behavioral health
• Home and community-based services (HCBS) such as Community-Based Adult Services (CBAS) and Multipurpose Senior Services Program (MSSP)

IEHP DualChoice (HMO D-SNP) is a no-cost coverage program that integrates healthcare services to better coordinate care and improve health. It provides coverage to qualified low-income California residents. The Plan Benefits and Cost Sharing provides information about plan benefits, which are the types of medical care that are covered, and information on cost-sharing, which is how much the enrollee will pay for services or prescription drugs, including monthly plan premium and co-payment.

People who have both Medicare and Medi-Cal. For a complete list of who is included or excluded, visit Who Qualifies?

The IEHP DualChoice (HMO D-SNP) Formulary is a continually updated list of drug products designed to reflect the most appropriate, high quality and cost-effective drug therapies.

The Inland Empire Health Plan Pharmacy and Therapeutics (P&T) Subcommittee develops and monitors the Formulary. The P&T is composed of the IEHP Chief Medical Officer, Medical Directors, Director of Pharmaceutical Services, physicians from various medical specialties, local communities, and clinical pharmacists. This panel reviews the medications in all therapeutic categories based on safety, clinical efficacy, and cost-effectiveness and selects the most appropriate drugs in each class.

Formulary development and maintenance is a dynamic process. The IEHP P&T Subcommittee is responsible for developing, managing, updating and administering the Formulary. The Subcommittee also ensures that the IEHP Formulary remains responsive to the needs of our members and providers.

You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Click here to download a free copy by clicking Adobe Acrobat Reader. By clicking on this link, you will be leaving the IEHP website.

Exceptions to criteria or requests for coverage of drugs not on the IEHP DualChoice (HMO D-SNP) Formulary may be submitted by prescribers on CoverMyMeds or the IEHP pharmacy benefits website https://www.medimpact.com/Prior-Authorization-Forms. IEHP delegates prior authorization requests to the Pharmacy Benefit Managers (PBM). Grievance and Appeals and Physician Administered Drugs (PAD) prior authorization requests are reviewed by IEHP.

Information on this page is current as of June 28, 2024.