San Mateo County ACE Program

Prescriptions & Pharmacies

Covered Drugs

• Brand and generic medications prescribed by your doctor that are in the ACE Formulary (below)
• Non-formulary drugs that your doctor prescribes and gets prior authorization for from HPSM
• Some over-the-counter medicines may be covered if you have a doctor's prescription
  

Drugs not covered

• Over-the-counter medicines that do not require a doctor's prescription
• Dietary supplements
• Drugs for breast, cervical or prostate cancer
• Birth control
• Experimental medicines

Participant Cost

Co-pay for covered medications is $7.

Patient Assistance Programs (PAP)

When you are seen by a specialist physician, and he/she prescribes a specialty medication (usually a high cost specialized prescription medication) there may be an opportunity for you to qualify for the drug manufacturer’s Patients Assistance Program (PAP). You would need to apply for the PAP, and if approved by the PAP, you may be able to get the prescription medication at a very low or at no cost to you. Talk to your doctor or specialist to get more information and how to apply for the PAP.

Pharmacy Network

Prescriptions are covered only if they are filled at a network pharmacy linked to your primary care provider (PCP) clinic. Your prescription will not be approved at a pharmacy that is not on your clinic’s list.

If your prescription is denied at the pharmacy, call your doctor. Your doctor needs to request a prior authorization from HPSM to get coverage for that drug by filling out the Pharmacy Prior Authorization Request Form and faxing it to 650-829-2045. Your physician’s approval is required.

Search for a covered drug