Preferred Drug List

Contra Costa Health Plan has adopted a Preferred Drug List (PDL). Starting July 15, 2002 all new prescriptions for CCHP patients (except permanent County employees) must be taken from our PDL formulary or be accompanied by a Medication Prior Authorization Request (PA) form. Both of these documents are available for download in PDF format:

CCHP Preferred Drug List (PDL) (PDF, 73pp.)

- updated July 12, 2010

Prior Authorization Request (PA) form (170k PDF, 1p.)

- updated Jan 26, 2010

Medication Prior Authorization Request (PA) form (170k PDF, 1p.)

- updated Jan 26, 2010

Erectile Dysfunction Medication: Questionnaire and Prior Authorization Form (457k PDF, 1p.)

- updated July 3, 2006

Synagis Prior Authorization Request form (118k PDF, 1p.)

- 2009-2010 Nov - Mar Season

Direct Member Reimbursement Form (131k PDF, 2pp.)

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The Preferred Drug List is the prescription drug formulary for the Contra Costa Health Plan.

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