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.
Starting of January 1, 2022, Medi-Cal Rx will be responsible for the following pharmacy benefits when billed by a pharmacy on a pharmacy claim. For Medi-Cal Rx’s formulary, also known as the Contract Drugs List (CDL) please visit Medi-Cal Rx’s homepage, under Tools and Resources.
For Medi-Medi members, you can refer to the CDL for the over the counter drugs and over the counter cold/cough preparations lists Medi-Cal Rx covers.
SFHP Healthy Workers HMO 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.
Step Therapy Table (PDF format) Posted 11-20-2023
COVID-19 Vaccine Access & Pharmacy Billing Information (PDF format) Posted 03-26-2021