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Member Services

Toll free: 1-800-750-4776
Local: 650-616-2133
TTY: 1-800-735-2929 or dial 7-1-1

Phone hours: Monday–Friday 8:00 a.m. to 6:00 p.m.
Office hours: Monday–Friday 8:00 a.m. to 4:00 p.m.
Email: [email protected]

The provider directory is updated every week; however there may be incorrect or new information about a provider that has not yet been updated. If you find an error, please call 650-616-2106 extension 5 (for TTY: 800-735-2929 or 711). You can also email HPSM Provider Services at [email protected].

HealthWorx HMO

Prescriptions & Pharmacies

Covered medicines

When prescribed by a doctor:

  • Brand and generic medicines in the HealthWorx (HMO) Formulary 
  • Prenatal vitamins and birth control
  • Diabetic supplies (medicines such as insulin, needles and testing equipment)
  • Stop smoking patch or gum
  • Products for the treatment of phenylketonuria
  • Non-formulary medicines that your doctor prescribes and gets prior authorization for from HPSM

Not covered

  • Over-the-counter medicines (including dietary supplements)
  • Experimental medicines
  • Medicines for cosmetic use
  • Medicines for erectile dysfunction

Cost

  • $3 co-pay for generic medicines (medicines with a Drug Tier 1 on the formulary book and formulary search tool)
  • $10 co-pay for brand medicines (medicines with a Drug Tier 2 on the formulary book and formulary search tool)

Co-pays for medicines that are non-formulary (not on the formulary covered medicines list) depend on whether they are generic or brand. If you have questions, contact Member Services for assistance.

Medicines 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 medicines 
    • Mifepristone
    • Misoprostol

Search for a covered medicine 

 Search

Use the formulary search form to find covered medicines by generic or brand name, or view all medicines within a category.

Filling prescriptions

Most of the time, your medicines 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

Search

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 [email protected] or call Member Services.