HealthWorx HMO

Prescriptions & Pharmacies

Covered Drugs

When prescribed by a doctor:

  • Brand and generic medications in the Healthy Kids HMO Formulary (below)
  • 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 covered medications prescribed by your doctor
  • $10 co-pay for brand medication when generic option is available

Search for a covered drug

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

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

Pharmacy for specialty drugs

If you have to get a drug for a chronic health issue, you may need to go to a specialty pharmacy to be able to fill your prescription. Alphascript is HPSM's preferred pharmacy for specialty drugs.

To find out if you need to use Alphascript:

Call Member Services, your doctor or Alphascript. To avoid delays in getting your drugs, call Alphascript on the day that you get your prescription. Call before you leave your doctor’s office or clinic, if you can.

Call Alphascript at 1-800-780-3584

Health issues that are treated with specialty drugs
  • HIV/AIDS
  • Cancer
  • Hepatitis B
  • Hepatitis C
  • Cystic fibrosis
  • Rheumatoid arthritis
  • Multiple sclerosis
  • Crohn’s disease
  • Kidney disease
  • Organ transplant
  • Psoriatic arthritis
  • Ulcerative colitis
  • Plaque psoriasis
  • Bone marrow transplant

Many self-injectable drugs are specialty drugs (insulin is not one of them)