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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.

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 Member ID Card to the pharmacy staff at your preferred pharmacy.

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 or 1(800) 288-5555 toll free.

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.

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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 found below and send it back to us with your payment receipts.
    DMR Form
  2. Mail or fax the DMR form and your payment receipts to us. Mail to:
    Magellan Health Services
    Attn: Claims Department
    P.O. Box 1599
    Maryland Heights, MO 63043
  3. Fax number: 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.


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