CareMore Cal MediConnect

Formulary Request Form

If you would like a mailed copy of the formulary (list of covered drugs), please call Member Services at 1-888-350-3447 (TTY: 711) Monday - Friday 8 a.m. to 8 p.m. PST, or complete the information below.

(*) Indicates a Required field.

Are You*


Are You a Current Cal MediConnect Plan Member*

Plan Year Requested










Alternate Format