HealthWorx HMO
Prescriptions & Pharmacies
Covered Drugs
When prescribed by a doctor:
- Brand and generic medications in the HealthWorx (HMO) Formulary
- Prenatal vitamins and birth control
- Diabetic supplies (medications such as insulin, needles and testing equipment)
- Stop smoking patch or gum
- Products for the treatment of phenylketonuria
- Non-formulary drugs that your doctor prescribes and gets prior authorization for from HPSM
Not covered
- Over-the-counter medicines (including dietary supplements)
- Experimental medicines
- Medication for cosmetic use
- Medications for erectile dysfunction
Cost
- $3 co-pay for generic medications (medications with a Drug Tier 1 on the formulary book and formulary search tool)
- $10 co-pay for brand medications (medications with a Drug Tier 2 on the formulary book and formulary search tool)
Copays for medications that are non-formulary (not on the formulary covered drug list) depend on whether they are generic or brand. If you have questions, contact Member Services for assistance.
Medications available to you at no charge include items such as:
- All vaccines
- Tobacco cessation products
- Prenatal vitamins containing Folic Acid 0.4mg or 0.8mg
- Contraceptives
- HIV pre-exposure prophylaxis
- Truvada (Emtricitabine and Tenofovir Disoproxil Fumarate)
- Descovy
- Breast Cancer prevention treatment
- Tamoxifen
- Anastrozole
- Letrozole
- Abortion medication
- Mifepristone
- Misoprostol
Search for a covered drug
Filling prescriptions
Most of the time, your drugs are covered only if they are filled at HPSM network pharmacies.
If your prescription is denied at the pharmacy, call your doctor. Your doctor will need to ask for pre-approval from HPSM. They can do this by filling out the Pharmacy Prior Authorization Request Form and the Pharmacy Prior Authorization Request Form and faxing it to 650-829-2045.
Search for a pharmacy
The HPSM network has 234 pharmacies in San Mateo County and San Francisco
- Search by pharmacy name or location
- Click on a pharmacy name for more information
- Includes links to maps and directions
- Print or save information about pharmacies
- Weekly updates ensure you get the best results
Pharmacies outside your area
The HPSM network has pharmacy chains with stores around the country. You can use these when you go outside of San Mateo County.
- Costco: 1-800-607-6861
- CVS: 1-800-746-7287
- Target: 1-800-440-0680
- Rite Aid: 1-800-748-3243
TTY/TDD: 1-800-821-1833 - Walgreens: 1-800-925-4733
For more information about HealthWorx prescriptions and pharmacies, refer to section 6 of the HealthWorx HMO Evidence of Coverage. To order a printed EOC, email CustomerSupport@hpsm.org or call Member Services.