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.

For more information or to see if a specific drug is covered under the Healthy Workers HMO program call SFHP Customer Service at 1(415) 547-7800, 1(800) 288-5555 (toll-free), or 1(888) 883-7347 (TTY), Monday – Friday, 8:30am – 5:30pm.

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

San Francisco Health Plan Healthy Workers HMO has added a mail order pharmacy, Prime Therapeutics Pharmacy, to the pharmacy benefit to provide our members with more options to get their medications.

How to use the mail order option for your medications

If you have an active prescription with remaining refills:

• Call 1(800) 424-8274 (TTY 711) Monday – Friday, 5am – 4pm Pacific Time (PT) with your prescription and previous pharmacy information. Prime Therapeutics Pharmacy will request a transfer for you.

If you need a new prescription:

• Ask your prescriber to send your prescription to Prime Therapeutics Pharmacy. Prescribers can submit new prescriptions through one of three ways:
  1. ePrescribe to Prime Therapeutics Pharmacy LLC (Home Delivery, Salt Lake City), NPI 1609221647
  2. Fax the prescription to 1(888) 282-1349
  3. Call the prescription in to 1(800) 424-8274

Members can call 1(800) 424-8274 to speak to a patient care coordinator about their prescriptions.

Prime Therapeutics Pharmacy

Business hours:

Monday – Friday from 5am – 4pm, Pacific Time (PT)

After hours (for urgent and emergency requests only):

Monday – Friday from 5pm – 5am, Pacific Time (PT)
Saturday – Sunday all day

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?

1. Complete the DMR form and send it back to us with your payment receipts.
2. Mail the DMR form and your payment receipts to us. Mail to:
   Prime Therapeutics
   Attn: Claims Department
   P.O. Box 1599
   Maryland Heights, MO 63043
3. Fax the DMR form to 1(800) 424-7578

If you need help reading this letter in another language, please contact San Francisco Health Plan at 1(800) 288-5555 (toll-free).