Prescription Drugs and Pharmacy Benefits
If you need medications to treat your illness or condition, your doctor will give you a prescription. Once you choose a pharmacy, take your prescription to that pharmacy to get your medication. Your doctor may also send it to the pharmacy for you. Make sure the pharmacy knows about all of the medications you are taking and any allergies you have. If you have any questions about your prescription, make sure you ask the pharmacist.
If you are told that a medication is not covered by your insurance or you are asked to pay for a medication, here is what to ask:
- If the pharmacy tells you the drug is not covered, ask the pharmacy staff why the drug is not covered.
- If the pharmacy says the drug has been denied, ask if the medication needs prior authorization from the Alliance. The pharmacy staff will need to let your doctor know to request prior authorization with any needed medical information. See Medications Not Included in the Formulary.
- You can also call your doctor to ask if there is another drug that would be covered instead.
Always follow up with your doctor or the Alliance if you are unable to get a medication that has been prescribed by your doctor. If you need help or have more questions, call Member Services.
The Alliance contracts with a company called MedImpact to provide pharmacy services. If you are filling or refilling a prescription, you must get your prescribed drugs from a pharmacy that works with MedImpact.
You can find a list of pharmacies that Alliance members can go to in the Alliance Provider Directory. You can also call Member Services for more information.
Some of the pharmacies in our network have locations in other parts of California. If you are going outside of the Alliance service areas (Santa Cruz, Monterey and Merced counties), call Member Services to see if there is an approved pharmacy nearby.
Specialty Drugs and US Bioservices Specialty Pharmacy
Some drugs are known as specialty drugs. The Alliance uses a specialty pharmacy called US Bioservices, which is also listed in our Alliance Provider Directory. Specialty drugs have the letters “SP” in the formulary and need to be filled at US Bioservices.
Specialty drugs may have special handling or storage requirements., You might also need extra guidance from a care team at the pharmacy for that drug. The pharmacy will let you know if any of the drugs you are prescribed are specialty drugs, and what you need to do with them.
You may ask to not use US Bioservices pharmacy services by calling Member Services. The Alliance may allow you to use a different specialty pharmacy, but not the retail pharmacy of your choice. This is because only specialty pharmacies carry specialty drugs. Sometimes, only one or two pharmacies have access to dispense a particular drug.
Alliance Care IHSS Copayment
For copayment information on prescription drug tiers, see the Alliance Care IHSS Evidence of Coverage (EOC) handbook.
When you choose a pharmacy, take your prescription to that pharmacy. Give the pharmacy your prescription with your Alliance ID card. Make sure the pharmacy knows about all medications you are taking and any allergies you have. If you have any questions about your prescription, make sure you ask the pharmacist. If you need to get a prescription filled at an out-of-area pharmacy because of an emergency or for treatment of an urgent medical condition, please ask the pharmacy to call Member Services. We will explain to the pharmacy how they can bill us for the drug.
The Alliance pays for medications that are listed in our formulary. A formulary is a list of the drugs and medications that the plan covers. Every Alliance doctor has this list. Drugs on the list have been chosen for their safety and effectiveness. Your doctor should order drugs from this approved list.
To access the current formulary online, see the complete list of covered medications. If you would like a copy of our formulary, please call Member Services.
Medications Not Included in the Formulary
Our formulary does not list all the drugs. If your doctor thinks you need a medication that is not on our list of approved drugs, they will need to send us a form called a prior authorization request. We will review the request and approve or deny it based on the information your doctor gives us.
Drugs that need prior authorization have the letters “PA” in the formulary. When there is more than one drug that can treat a medical condition, we may need your doctor to try prescribing you the covered drug before requesting authorization to prescribe any others. This is known as step therapy. Your provider may request an exception to the step therapy process for a prescription drug.
Emergency Prescription Supply
In emergency situations, such as after hospital discharge, you might need your medications quickly and may not be able to wait for a prior authorization from the Alliance. In these cases, your pharmacy can call MedImpact to give you a 5-day emergency supply of drugs with no out-of-pocket cost to you. If there is a state of emergency issued in your local area, your pharmacy can also call MedImpact to give an emergency supply for your drugs. This means you can still get the drugs you need during an emergency without waiting for prior authorization from the Alliance.
You can get a 90-day supply of most prescription medications mailed to you through the Alliance’s contracted mail-order pharmacy, MedImpact Direct (MID).
Mail-order prescription services with standard shipping are a covered benefit for Alliance members.
To get your prescriptions mailed to you, please register online with MedImpact Direct.
When you register with MedImpact Direct, you can request refills of current prescriptions or have a new prescription filled by phone, mail or by a fax from your doctor.
Call MedImpact Direct (MID) at 855-873-8739.
- Monday through Friday from 7 a.m. to 7 p.m.
- Saturday from 8 a.m. to 4 p.m.
Download and complete the MedImpact Direct Medication Order Form.
Mail the form with your prescription to:
PO Box 51580
Phoenix, AZ 85076-1580
Once MedImpact Direct has your order, you can order refills and customize your delivery options for future orders.
Fax from doctor
Ask your doctor to send your prescription electronically or by fax to MedImpact Direct at 888-783-1773.
The pharmacy staff at MedImpact Direct will call you to get approval before they process the prescription.
It is important to get rid of unwanted or expired medicines and sharps safely.
Sharps are hypodermic needles, pen needles, pre-loaded sharps, auto-injectors, intravenous needles, lancets and other devices used to pierce the skin for drawing blood or for the delivery of medications. Sharps must be kept in sharps containers approved by the U.S. Food and Drug Administration.
Your county has specific drop off locations for both medicines and sharps:
Santa Cruz County
Contact Member Services
- Monday through Friday, from 8 a.m. to 5:30 p.m.
- Phone: 800-700-3874
- Deaf and Hard of Hearing Assistance
Alliance TTY Line: 877-548-0857
- Nurse Advice Line
Accessing Alliance Services
© 2021 Central California Alliance for Health