Pharmacy Services and Find a Pharmacy
Pharmacy Materials
Prescriptions
Prescription drugs are part of your benefits. If you need medicine, your Primary Care Provider (PCP) will write a prescription for you.
To get your medicine, show your SFHP Care Plus Member ID Card and your prescription to a pharmacy that is part of SFHP Care Plus network. Your doctor can also send the prescription straight to the pharmacy you choose.
To have your medicine covered by SFHP Care Plus, you must:
- Use a pharmacy that’s in the SFHP Care Plus network.
- Make sure the medicine is approved on our online searchable formulary tool.
- If your medicine isn’t on the list, it might still be covered if your doctor asks for a Prior Authorization.
- Follow any rules or limits for using the medicine.
Find a Pharmacy
As an SFHP Care Plus member, you have access to pharmacies in San Francisco as well as over 300 more pharmacies in our five surrounding counties (Marin, Contra Costa, Alameda, Santa Clara, and San Mateo). SFHP Care Plus also offers a Mail Order option for your convenience. Search for Pharmacies or view the printable directory.
Real Time Benefit Tool
Use our Real Time Benefit Tool to get an estimate of what you’ll pay for drugs and if there are other drug options that could treat the same condition. Visit our Member Portal to view your current pharmacy benefit information. To make a new account (or log into your existing one), go to sfhp.org/careplus-portal.
Low-Income Subsidy (LIS) Extra Help
Most Medi-Cal members qualify for the Low-Income Subsidy (LIS or Extra Help). LIS assists with Part D prescription drug costs.
If you are eligible for any of the programs below, you will qualify for extra help through LIS:
Joining SFHP Care Plus will automatically enroll you into the LIS program. Learn more about the Extra Help program at ssa.gov/medicare/part-d-extra-help.
Depending on your LIS eligibility, your 2026 cost share for Care Plus covered drugs are listed below:
| LIS 1 | LIS 2 | LIS 3 | |
|---|---|---|---|
| Tier 1 – Preferred Generic | $0 | $0 | $0 |
| Tier 2 – Generic | $5.10 | $1.60 | $0 |
| Tier 3 – Preferred Brand | $12.65 | $4.90 | $0 |
| Tier 4 – Non-Preferred Generic and Brand | $5.10 generic $12.65 brand |
$1.60 generic $4.90 brand |
$0 |
| Tier 5 – Specialty | $5.10 generic $12.65 brand |
$1.60 generic $4.90 brand |
$0 |
| Tier 6 – Select Care | $0 | $0 | $0 |
If Medicare does not have up-to-date info about whether you qualify for Low-Income Subsidy Extra Help, you may be charged more than you should. Medicare’s Best Available Evidence (BAE) policy lets SFHP Care Plus use current info to see if you can get Extra Help. Learn more about the BAE policy from Medicare here.
Member Grievance and Appeals Process
If you would like to file a grievance or an appeal, visit Medicare.gov or the Grievance and Appeal page.
If you need help or have questions, call SFHP Care Plus Customer Service at
Email: [email protected]