Prescriptions & Part D
As a Santa Clara Family Health Plan DualConnect (HMO D-SNP), (SCFHP DualConnect) member, you can fill your prescription at over 200 pharmacy locations in Santa Clara County and at chain pharmacies nationwide. To fill your prescription, show your SCFHP DualConnect member ID card and your prescription to any participating pharmacy. You can also get a 90-day supply of most prescription maintenance medications for the same copay as a 30-day supply. Talk to your doctor about getting a prescription for a 90-day supply. You can pick it up at a network pharmacy or have it mailed to you. To find out more about our mail-order services, visit www.medimpactdirect.com or refer to the SCFHP DualConnect Member Handbook in Member Materials.
SCFHP DualConnect will usually cover your drugs as long as you follow the rules:
- You must have a doctor or other healthcare provider write your prescription.
- You must use a network pharmacy to fill your prescription.
- Your drug must be on the SCFHP DualConnect List of Covered Drugs (Formulary), also called the "Drug List" for short.
- If it is not on the Drug List, we may be able to cover it by giving you an exception. For more information, see Coverage Decisions & Exceptions.
- You must meet any applicable coverage requirements or limits on use.
When a safe, lower-cost drug will work just as well as a higher-cost drug, we expect your provider to prescribe the lower-cost drug.
For more information on your prescriptions and Part D benefits and services, click the + buttons below or refer to the SCFHP DualConnect Member Handbook and List of Covered Drugs available in Member Materials in multiple languages.
If you would like to make a complaint or grievance or file an appeal, go to Complaints, Grievances & Appeals.
Frequently asked questions
Tiers are groups of drugs on our plan’s Drug List. Every drug on our Drug List is in one tier. You have no copays for prescription and OTC drugs on our Drug List. To find the tiers for your drugs, refer to our Drug List.
Tier 1 drugs are generic, brand name, and biosimilar drugs. The copay is $0.
If you are new to SCFHP DualConnect or your level of care changes, there may be drugs you are taking that are not on the Drug List. In this case, you may still be able to fill your prescription.
See Drug Transition Policy & Process for more information.
For certain prescription drugs, special rules limit how and when SCFHP DualConnect covers them. In general, our rules encourage you to get a drug that works for your medical condition that is safe and effective.
If you or your provider thinks our rules should not apply to your situation, you should ask us to make an exception. You may also request drugs not on our Drug List to be covered. This is called a formulary exception.
For more information, see Coverage Decisions & Exceptions.
The SCFHP DualConnect List of Covered Drugs (Formulary) tells you which prescription drugs are covered by SCFHP. The Formulary also tells you if there are any rules or restrictions on any drugs, such as a limit on the amount you can get. To learn more, see List of Covered Drugs in Member Materials. Or you can use the online formulary search tool to find a drug and see what rules apply to it. The online formulary search tool is updated every month.
To request a hard copy of the SCFHP DualConnect Formulary in the mail, please click here to submit an online request, or call SCFHP DualConnect Customer Service at 1-877-723-4795 (TTY: 711), Monday through Friday, 8 a.m. to 8 p.m.
You can make a standing request to get this document in a language other than English or in an alternate format. We will keep this information on file for future mailings. You do not need to make a separate request each time. To make or change your request, call SCFHP DualConnect Customer Service, submit an online request, or send a request in writing to:
Attn: Customer Service Department
Santa Clara Family Health Plan
PO Box 18880
San Jose, CA 95158
If you take medications for different medical conditions, you may be able to get services, at no cost to you, through a Medication Therapy Management (MTM) program. This program helps you and your provider make sure that your medications are working to improve your health. The Medication Therapy Management program is voluntary and free to members who qualify.
See Medication Therapy Management for more information.
Find a pharmacy using the "Find a Doctor" search tool or by downloading the SCFHP Cal MediConnect Provider and Pharmacy Directory in your language from Member Materials.
To request a hard copy of the SCFHP Cal MediConnect Plan Provider and Pharmacy Directory in the mail, please click here to submit an online request, or call SCFHP Cal MediConnect Plan Customer Service at 1-877-723-4795 (TTY: 711), Monday through Friday, 8 a.m. to 8 p.m.
You can make a standing request to get this document in a language other than English or in an alternate format. We will keep this information on file for future mailings. You do not need to make a separate request each time. To make or change your request, call SCFHP Cal MediConnect Plan Customer Service, submit an online request, or send a request in writing to:
Attn: Customer Service Department
Santa Clara Family Health Plan
PO Box 18880
San Jose, CA 95158
NOTE: Network pharmacies may have been added or removed after the SCFHP Cal MediConnect Plan Provider and Pharmacy Directory was printed. Please contact SCFHP Cal MediConnect Plan Customer Service at 1-877-723-4795 if you have questions regarding pharmacy locations. TTY users should call 711.
See Find a Pharmacy for more information.
You can ask for published materials for free in other formats, such as large print, Braille, or audio. Call SCFHP DualConnect Customer Service for help.
If you are more comfortable speaking a language other than English, Santa Clara Family Health Plan can help you. Whether you are contacting SCFHP or visiting a doctor, we have interpreters available. Tell your doctor you would like an interpreter for your visit.
Know your rights
- You can get an in-person or telephone interpreter at no cost to you. This includes American Sign Language.
- When you go to the doctor, interpreters are available 24-hours a day.
- You can ask for SCFHP DualConnect materials written in other languages.
How can you get an interpreter?
Tell your doctor’s office you would like one. You can do this when you call to set up your next visit. You can also ask us for an interpreter or for translated materials.