CareAdvantage Dual Eligible Special Needs Plan (D-SNP) 2024

Pharmacy Services

In general, CareAdvantage only covers prescriptions that are filled by network pharmacies. However, there are certain circumstances under which CareAdvantage will reimburse you for prescriptions filled by out-of-network pharmacies. Quantity limits and restrictions may apply.

For the over-the-counter drugs and vitamins that are covered under Medi-Cal Rx, you can find a network pharmacy in the Medi-Cal Rx Pharmacy Directory at medi-calrx.dhcs.ca.gov. You can also find a pharmacy near you by calling Medi-Cal Rx at 1-800-977-2273 (TTY 800-977-2273 and press 5 or 7-1-1).

Pharmacy Mail Order Benefits

CareAdvantage has partnered with Postal Prescription Services (PPS) to offer mail order pharmacy services at no extra cost.  You pay the same copay as you would at your local pharmacy since shipping is free.  Most medications arrive at your door no more than seven to ten days. 

Getting Mail Order Benefits

PPS can either ask for a new prescription from your provider or call your current pharmacy to move your prescription(s) over.  To start the process you can:

1. CONTACT PPS BY PHONE: 1-800-552-6694 to create an account.
2. SET UP A PPS ACCOUNT ONLINE
   • Visit ppsrx.com and select "Create an Account"
   • Select "Add a Patient".   Note: f you have not filled a prescription with PPS, you will need to select "Request New Patient" and follow the steps to set up your new patient profile.
   • Follow instructions to "Add Online Prescription Management" to request first refill.

CareAdvantage Network Pharmacies

The CareAdvantage network includes more than 200 pharmacies in San Mateo County and San Francisco. Outside of these areas, you can fill prescriptions at the following chain pharmacies:

• Costco: 1-800-607-6861
• CVS: 1-800-746-7287
• Lucky: 1-800-692-5710
• Rite Aid: 1-800-748-3243 TTY/TDD: 1-800-821-1833
• Safeway: 1-877-723-3929
• Target: 1-800-440-0680
• Walgreens: 1-800-925-4733

Search for a pharmacy

Prescription Reimbursements

If you pay the full cost of a prescription, CareAdvantage will reimburse you under certain circumstances, such as when you

• Fill a prescription in an emergency situation at a non-network pharmacy
• Need a specialized drug that is not available at a network pharmacy
• Need a drug that is only available, by law, at specific pharmacies

Note that HPSM will not reimburse you for your Part D prescription co-pay.

To Request Reimbursement

Send a copy of your pharmacy receipt to:

Or email a copy of your pharmacy receipt to customersupport@hpsm.org.

For information regarding prescription reimbursement requests for Medi-Cal Rx covered over-the-counter drugs and vitamins, please visit the Medi-Cal Rx website (www.medi-calrx.dhcs.ca.gov). You can also call the Medi-Cal Rx Customer Service Center at 1-800-977-2273.