The San Francisco Health Plan Formulary is a list of medications reviewed and approved by our Pharmacy and Therapeutics (P&T) Committee. The P&T Committee is comprised of actively participating network providers and pharmacists who select products on the basis of their safety, efficacy and quality. Providers are requested to prescribe medications included in the formulary whenever medically appropriate.
SFHP Medi-Cal Formulary
SFHP Healthy Kids Formulary
SFHP Healthy Families Formulary
SFHP Medi-Medi Formulary
Step Therapy Edits
San Francisco Health Plan has Step Therapy (ST) medications listed on formulary. These drugs will process at the point of sale at the pharmacy, if the required medications have been tried and failed with paid claims. If paid claims do not exist, a prior authorization request must be submitted for consideration of coverage.
SFHP Pharmacy Prior Authorization Requests
SFHP Pharmacy Prior Authorization Requests can be submitted by providers one of three different ways:
- Fax: Download a Prior Authorization Request Form and fax to (855) 811-9330 for standard requests or (855) 811-9331 for urgent requests.
- Call: Pharmacy Benefits Manager (PBM) PerformRx at (888) 989-0091 to submit a verbal request
- Online: Submit using the Online Pharmacy Prior Authorization Request Form
Prior Authorization Criteria
The following is a listing of SFHP prior authorization criteria that will be used to evaluate prior authorization requests. SFHP’s pharmacy prior authorization criteria is based on clinical monographs and National Pharmacy and Therapeutics (P&T) and has been approved by the SFHP Pharmacy and Therapeutics (P&T) Committee.
* Prior Authorization Criteria will be updated to reflect ongoing changes and is subject to change.
Downloadable SFHP Pharmacy Prior Authorization Criteria – last updated 7/2013
Request for Formulary Modification
San Francisco Health Plan holds quarterly Pharmacy and Therapeutic (P&T) Meetings with committee members from the community to discuss any clinical updates or changes. Suggestions for formulary modification will be addressed. If you have a formulary suggestion, please fill out Formulary Modification Request Form and fax it to (415) 547-7819 and it will be addressed at the following (P&T) meeting.
US Bioservices is San Francisco Health Plan’s specialty pharmacy provider. Specialty drugs often require special storage and handling. These types of drugs may be injected, infused or taken by mouth. US Bioservices’ skilled pharmacists and nurses offer extra support to our members requiring specialty medications 24 hours a day, 7 days a week. You can reach US Bioservices at (888) 518-7246 or visit them at www.usbioservices.com.
- Epocrates Rx – Enables formulary downloads to your handheld Palm OS PDA or Pocket PC
- Epocrates Online – Allows formulary access from any internet connected computer
- View Epocrates information ona full-size computer screen
- Quickly access all the health insurance formularies in which your patients participate
- Print or email Epocrates content
- Provide your colleagues/staff with desktop access to Epocrates drug safety information
Register now at: http://www.epocrates.com/products/
!! A SPECIAL ALERT ABOUT MEDI-CAL FORMULARIES IN SAN FRANCISCO !!
Each of the three types of Medi-Cal in San Francisco County have a different drug formulary. Please remember to check the type of Medi-Cal your patient has before prescribing medication. Click on the icons below to link to the different formularies.
|Type of Medi-Cal||
Where to find the formulary
|San Francisco Health Plan Medi-Cal|
|Blue Cross Medi-Cal|
|Fee-for-service (regular) Medi-Cal|