Santa Clara Family Health Plan (SCFHP) contracts with most chain and independent pharmacies in Santa Clara County.
To fill your prescription, show your SCFHP member ID card and your prescription to any network pharmacy.
Frequently asked questions
Network pharmacies are listed in the following places:
- Your Medi-Cal Provider and Pharmacy Directory. Find a copy in Forms & Documents.
- Your Cal MediConnect Provider and Pharmacy Directory. Find a copy in Member Materials.
- Find-a-doctor search tool. Use the Facility tab to search for network pharmacies.
- The pharmacy locator tool in the mySCFHP member portal. Sign up for an account!
If you need a printed copy of the directory mailed to you, fill out and submit this request form. Or contact Customer Service.
- Medi-Cal members, call 1-800-260-2055 (TTY: 711) Monday through Friday, 8:30 a.m. to 5 p.m.
- Cal MediConnect members, call 1-877-723-4795 (TTY: 711) Monday through Friday, 8 a.m. to 8 p.m.
For information about which drugs are covered in your plan, please see the Drug Formulary. This is also called List of Covered Drugs or Drug List for short. The Formulary is listed in the following places:
- Your Medi-Cal Formulary. Find a copy in Forms & Documents.
- Your Cal MediConnect List of Covered Drugs. Find a copy in Member Materials.
- The pharmacy tools in the mySCFHP member portal. Sign up for an account!
Cal MediConnect members, please visit the Cal MediConnect Prescriptions & Part D page for more information.
A Drug Formulary is a complete list of drugs covered by SCFHP. Both brand name and generic drugs are included. For brand name drugs, if the generic option is available, SCFHP requires the use of the generic drug.
Any drug that is not listed on the Drug Formulary is considered a non-formulary drug and requires prior authorization (pre-approval).
The drugs on the Drug Formulary are available at pharmacies within our network. A pharmacy is in our network if we have an agreement with them to work with us and provide you services. We refer to these pharmacies as “network pharmacies”.
See above on how to find a network pharmacy and what drugs are covered.
Attention Medi-Cal members, Medi-Cal Rx is coming April 2021
On April 1, 2021, the Department of Health Care Services (DHCS) will change the pharmacy benefit for SCFHP Medi-Cal Members. Your prescription medications will be covered by “Medi-Cal Rx.” This does not change your Medi-Cal eligibility or benefits.
If you are eligible for both Medicare and Medi-Cal, Medi-Cal Rx may cover prescriptions Medicare does not, so you should talk to your doctor or pharmacy if you have any questions.
Note: Cal MediConnect members will continue to get their pharmacy benefits through SCFHP not Medi-Cal Rx.
Medi-Cal Rx frequently asked questions
Starting on April 1, 2021 you will get your Medi-Cal covered prescriptions through Medi-Cal Rx instead of Santa Clara Family Health Plan (SCFHP).
DHCS is working with a new contractor, Magellan Medicaid Administration, Inc. (Magellan) to provide Medi-Cal Rx services.
There will be no change in how you pay for your medications. For most Medi-Cal beneficiaries, there is no cost.
SCFHP, your doctors, and pharmacies know about the changes and know what to do. Because of this, most people in Medi-Cal will not need to do anything.
Most people will be able to use the same pharmacy they do now on April 1, 2021. If your pharmacy does not work with Medi-Cal Rx, you may need to choose another pharmacy.
Most people will not have to change their medications. The list of drugs that require prior approval may be different than the list SCFHP uses. Your doctor may need to get approval to refill prescriptions. They may talk to you about changing to a medication that does not require prior approval.
Most pharmacies will accept your new coverage. You can call the Medi-Cal Member Help Line (1-800-541-5555, TTY 1-800-430-7077) to ask if your pharmacy will accept Medi-Cal Rx.
Always bring your SCFHP ID card and your Medi-Cal Benefits Identification Card (BIC) with you when you go to the pharmacy. The pharmacy will use the card to look up your information and give you your medications.
If you have questions about your medication or other pharmacy services, please call SCFHP Customer Service at 1-800-260-2055 (TTY: 711), 8:30 a.m. to 5 p.m., Monday through Friday.
If you have questions about the Medi-Cal Rx notices you are getting or have Medi-Cal Rx general questions, contact the Medi-Cal Member Help Line (1- 800-541-5555, TTY 1-800-430- 7077), Monday thru Friday, 8am to 5pm.
You can also email DHCS at RxCarveOut@dhcs.ca.gov. Make sure to write that you have a question about Medi-Cal Rx. Please do NOT include personal information in your first email. DHCS staff will reply with a secure email asking for your information, if they need that information to assist you.