Prior Authorization Requests

SFHP Pharmacy Prior Authorization Requests can be submitted by providers one of three different ways:

1. Fax: Download a Prior Authorization Request Form and fax to 1(858) 790-7100 for both standard and urgent requests. Urgent requests should be clearly labeled “URGENT” at the top of the prior authorization request form.
2. Call: Pharmacy Benefits Manager (PBM) MedImpact at 1(800) 788-2949 to submit a verbal request.
3. Online: Login to CoverMyMeds to access the online submission form. Once a PA form is completed, click the “Submit” button to send the Prior Authorization request to PBM MedImpact for review.

Prior Authorization Criteria
SFHP uses prior authorization criteria to evaluate prior authorization requests. These criteria are based on clinical monographs and national guidelines, and have been approved by the PBM’s Pharmacy Therapeutics (P&T) Committee with oversight from SFHP’s P&T committee.

Request for Formulary Modification
San Francisco Health Plan holds quarterly Pharmacy and Therapeutic (P&T) Meetings with committee members from the community to discuss any clinical updates or changes to the formulary made by the PBM’s P&T committee, which also meets quarterly. Suggestions for formulary modification will be addressed. If you have a formulary suggestion, please fill out the Formulary Modification Request form and fax it to 1(415) 547-7819. Your recommendation will be addressed at the subsequent (P&T) meeting.