Pharmacy Services & Find a Pharmacy
As a Healthy Workers HMO member, prescription medications are part of your health plan benefits. When you need medication, your Primary Care Provider will prescribe it.
What is a drug formulary?
SFHP has a drug formulary. The drug formulary is the list of drugs that SFHP will pay for. Even if a drug is listed on the SFHP drug formulary, your doctor may choose not to prescribe it for your particular condition. The formulary also includes Preferred and non-Preferred drugs. The co-payment for preferred drugs is $5 (generics) and the co-payment for non-Preferred drugs is $10 (brands).
Refer to your Healthy Workers HMO Evidence of Coverage and/or Summary of Benefits and Coverage for more information on your prescription medicine benefits. If you want to see if your prescription medicine is covered, refer to the San Francisco Health Plan Drug Formulary. – Posted 02/06/2026
HW Vaccine Drug List – Posted 02/01/2026
Preventive Drug List (ACA) – Posted 02/01/2026
Physician Administered Drugs Covered Under Healthy Workers HMO Outpatient Pharmacy Benefit (PAD) – Posted 02/01/2026
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.
If you need help or have questions, call SFHP Customer Service at
Find a Pharmacy
Using this Pharmacy Locator tool, you can select a preferred pharmacy from over 400 Pharmacies in San Francisco and our five surrounding counties (Marin, Contra Costa, Alameda, Santa Clara, and San Mateo).
Be sure to tell your healthcare provider that you have a preferred pharmacy so your prescriptions can be sent to the correct pharmacy location. To get your medications, show your San Francisco Health Plan Healthy Workers HMO Member ID Card to the pharmacy staff at your preferred pharmacy. If you would like to change your pharmacy, your prescriptions must be transferred to the new pharmacy you choose. Talk to the pharmacy staff at the new pharmacy location for assistance.
Mail Order Pharmacy
Healthy Workers HMO members can get medications delivered to their home through Birdi. Birdi is a fully accredited mail order pharmacy focused on patient care and service.
How to use the mail order option for your medications
If you have an active prescription with remaining refills:
- Call 1(855) 247-3479 (TTY: 711) to transfer your prescription.
If you need a new prescription:
- Ask your doctor to send a new prescription to Birdi using this number: NCPDP 23-72528
For questions or to learn more, visit birdirx.com or call 1(855) 247-3479 (TTY: 711)
Monday to Friday: 5:00am – 5:00pm PT
Saturday: 6:00am – 2:00pm PT
Healthy Workers HMO Prescription Drug Reimbursement Forms
What is Direct Member Reimbursement?
If you are an eligible Healthy Workers HMO member and you pay for a prescription covered by your plan, you can ask for this money back. To do this, you can fill out a claims form and give us your payment receipts. This process is called Direct Member Reimbursement (DMR).
When do I use DMR?
You can get back the money you pay for a covered prescription when:
- You are an active Healthy Workers HMO member, but you do not give the pharmacy your member identification (ID) card.
- You go to a pharmacy that is not in the Healthy Workers HMO network.
- You go to a pharmacy outside of the area covered by San Francisco Health Plan and Healthy Workers HMO.
You will still need to pay a copay for most medications.
How do I submit a claim for DMR?
- Complete the DMR form and send it back to us with your payment receipts. There are 3 ways to send:
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Mail:
MedImpact Healthcare Systems, Inc
PO Box 509098
San Diego, CA 92150-9108 - Fax: 1(858) 549-1569
- Email: [email protected]