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

Find 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

In general, your prescriptions are covered only if they are filled at HPSM network pharmacies.

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.

Find a pharmacy in your home area

The HPSM network has 234 pharmacies in San Mateo County and San Francisco.

  • Search by pharmacy name, health plan, location or type of provider
  • Search results include links to online maps and directions
  • Weekly updates ensure you get the most accurate results

Pharmacies outside your area

The HPSM pharmacy network includes chains that have pharmacies outside of the San Mateo County area, which you can use when traveling in the United States.

  • 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

Specialty medications

If you have been prescribed medicine for treatment of a chronic condition, a regular pharmacy may not be able to fill your prescription. Alphascript is HPSM's preferred pharmacy for specialty medications.

To find out if you need to use Alphascript:

Call Member Services, your doctor, or Alphascript. To avoid delays in filling your prescription, call Alphascript on the day that you receive your prescription (before you leave your doctor’s office or clinic, if possible).

Call Alphascript at 1-800-780-3584

Conditions that are treated with specialty medications:

  • 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 medications (insulin is not included).