Prescriptions & Part D
Prescriptions & Part D
Santa Clara Family Health Plan (SCFHP) Cal MediConnect 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.
Find a pharmacy by using the Find a Doctor search tool, or downloading the Provider and Pharmacy directory in your language below. To request a hard copy of the Provider and Pharmacy Directory in the mail, please click here to submit an online request, or call Customer Service at 1-877-723-4795, Monday through Friday, 8 a.m. to 8 p.m. TTY/TDD users should call 1-800-735-2929 or 711. The call is free.
You can ask for this information for free in other formats, such as large print, braille, or audio. Call SCFHP Customer Service at 1-877-723-4795, Monday through Friday, 8 a.m. to 8 p.m. TTY/TDD users should call 1-800-735-2929 or 711. The call is free.
Please note that network pharmacies may have been added or removed after the SCFHP Cal MediConnect Provider and Pharmacy Directory was printed. If you have questions regarding pharmacy locations, contact Customer Service at 1-877-723-4795. TTY/TDD users should call 1-800-735-2929 or 711.
Network pharmacies are pharmacies (drug stores) that have agreed to fill prescriptions for our plan members. You can fill your prescription at more than 250 network pharmacies.
Network pharmacies include:
- Retail and chain pharmacies
- Specialty pharmacies
- Mail-order pharmacies
- Home infusion pharmacies
- Long-term care pharmacies
You are not required to continue going to the same pharmacy to fill your prescriptions. You must fill your prescriptions at one of our network pharmacies if you want our plan to cover them, except during an emergency.
Generally, we pay for drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy. We have network pharmacies outside of our service area where you can get your prescriptions filled as a member of our plan.
We will pay for prescriptions filled at an out-of-network pharmacy in the following cases:
- When filling a specialized drug that is otherwise not available at a network pharmacy
- When filling a drug that has limited distribution source by law
- When filling a drug in an emergency situation when network pharmacies are not available, such as emergency illness while traveling or during a declared disaster
In these cases, please check first with Customer Service to see if there is a network pharmacy nearby.
You must use network pharmacies except in emergency or urgent care situations. If you go to an out-of-network pharmacy for prescriptions when it is not an emergency, you will have to pay out-of-pocket costs. For reimbursement on prescriptions you pay for, see the SCFHP Cal MediConnect Member Handbook, Chapter 7, Section A, or Chapter 5, Section A.
For certain kinds of drugs, you can use the plan’s network mail-order services. Generally, the drugs available through mail-order are drugs that you take on a regular basis for a chronic or long-term medical condition. Certain medications, such as controlled substances with a high potential for addiction or abuse are not available through mail-order. Our plan’s mail-order service allows you to fill up to a 90-day supply. A 90-day supply has the same copay as a one-month supply.
How do I fill my prescriptions by mail?
To get order forms and information about filling your prescriptions by mail, call Customer Service or go to www.medimpactdirect.com. If you use a mail-order pharmacy that is not in the plan’s network, your prescription will not be covered. Usually, a mail-order prescription will get to you within 10 calendar days. However, sometimes your mail-order may be delayed. If delivery is delayed or you are requesting an urgently needed medication, you may contact your PCP for an emergency prescription and take the prescription to any network pharmacy. The pharmacy may contact SCFHP to get an emergency override due to the delay in the mail-order process.
How will the mail-order service process my prescription?
- New prescriptions the pharmacy receives from you
The pharmacy will fill and deliver new prescriptions it receives from you.
- New prescriptions the pharmacy receives directly from your provider’s office
After the pharmacy receives a prescription from a health care provider, it will contact you to see if you want the medication filled immediately or at a later time. This will give you an opportunity to make sure the pharmacy is delivering the correct drug (including strength, amount, and form) and, if needed, allow you to stop or delay the order before it is shipped. It is important that you respond each time you are contacted by the pharmacy, to let them know what to do with the new prescription and to prevent any delays in shipping.
- Refills on mail-order prescriptions
For refills, please contact your pharmacy 10 days before you think the drugs you have on hand will run out to make sure your next order is shipped to you in time.
How do I contact the mail-order pharmacy?
SCFHP Cal MediConnect mail-order pharmacy:
PO Box 51580
Phoenix, AZ 85076-1580
Monday - Friday, 4 a.m. to 4 p.m.
Saturday, 5 a.m. to 1 p.m.
Call: 1-855-873-8739 (TTY dial 711)
View answers to frequently asked questions about mail-order pharmacy on MedImpact Direct's website at www.medimpactdirect.com/FAQ
You can ask for published materials for free in other formats, such as large print, braille, or audio. Call Customer Service for help.
If you speak a language other than English, language assistance services, free of charge, are available to you. Call Customer Service at 1-877-723-4795, Monday through Friday, 8 a.m. to 8 p.m. TTY/TDD users should call 1-800-735-2929 or 711. The call is free.
(8:00 a.m. - 8:00 p.m.
Monday - Friday)
Santa Clara Family Health Plan Cal MediConnect Plan (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook.
Enrollment in Santa Clara Family Health Plan Cal MediConnect Plan (Medicare-Medicaid Plan) depends on contract renewal. CMS (the Centers for Medicare & Medicaid Services) must approve SCFHP Cal MediConnect each year. You can continue to get health coverage as a member of our plan only as long as we continue to offer the SCFHP Cal MediConnect Plan for the year in question and CMS renews its approval of the plan. Even if SCFHP leaves the program, you will not lose health coverage. If SCFHP decides not to continue for the next calendar year, we must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare coverage in your area.
Last updated 12/31/2018