Santa Clara Family Health Plan contracts with most chain and independent pharmacies in Santa Clara County.
To fill your prescription, show your SCFHP member ID card and your doctor’s prescription to any participating pharmacy.
Cal MediConnect members please visit the Cal MediConnect Pharmacy Benefits & Services page.
SCFHP uses a list of approved outpatient drugs called a Drug Formulary. A Drug Formulary is a list of prescription and some non-prescription drugs. A plan physician prescribes these drugs and they can be obtained at a participating pharmacy. Even if a drug is listed on SCFHP’s Drug Formulary, it does not guarantee your health care provider will order that drug for a particular medical condition.
If you need a drug that is not on SCFHP’s Drug Formulary, your health care provider must first get an approval from SCFHP. If it is not approved, SCFHP will tell you why in a written notice. The notice will include a message about your right to file a grievance with SCFHP.
Santa Clara Family Health Plan will respond to a physician’s request for approval of a non-formulary drug within 24 hours or one business day.
Refer to your plan page for access to your specific plan’s Evidence of Coverage document. This document will tell you exactly what pharmacy services are covered under your plan.
For all plans, Santa Clara Family Health Plan’s pharmacy services provide the following:
Generic Drug Substitution
SCFHP Plan pharmacies will dispense generic equivalent prescription drugs if the prescribed drug is medically appropriate and safe for you. A generic drug is the pharmaceutical equivalent of a brand name drug, and has been approved by the Food and Drug Administration.
Phenylketonuria (PKU) Testing and Treatment
SCFHP covers screening, testing, and treatment of PKU (PKU is a rare condition in which a baby is born without the ability to absorb the nutrition they need from food).
For this condition, SCFHP will cover formula and certain special food products that may be prescribed for the treatment of PKU.
SCFHP covers medically necessary enteral formulas to prevent the development of serious disability or death in patients with medically diagnosed conditions or receiving food through a feeding tube that does not allow the full use of regular foods. This is a limited benefit for infants and children below the age of 21 years old; for anyone with a feeding tube; and for members 21 years of age or older who are orally fed and have intestinal malabsorption. The enteral formula must be prescribed by a Primary Care Provider or specialist and approved by SCFHP. Enteral formula feedings may meet certain dietary needs or may be used to help improve growth and development in infants and children who have been medically evaluated or are part of the Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT). Common household food items, experimental or investigational products are not covered by SCFHP.
For more information about the coverage listed above, please call our Member Services Department at 1-800-260-2055, or refer to your plan’s Evidence of Coverage document.