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Alliance Care IHSS Pharmacy

The Alliance has partnered with MedImpact, a Pharmacy Benefit Manager (PBM), to process pharmacy claims and prior authorization requests for Alliance Care IHSS members.

For physician-administered drugs billed as a medical claim, see Physician-Administered Drugs.

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Drug Formulary

Real-Time Prescription Benefits

MedImpact’s MedPrescription service provides prescribers with member-specific prescription eligibility, medication history and basic formulary information. Real-Time Prescription Benefits allows prescribers to view member-specific drug coverage, cost and benefit information such as prior authorization requirements or quantity limits, lower-cost therapeutic alternatives and preferred pharmacies. Additional information is available on the MedImpact website.

Prior Authorization Requests

Drugs that are not covered on the formulary, or drugs on the formulary with restrictions such as prior authorization (PA), step therapy or quantity limits may require prior authorization review to determine coverage for medical necessity. For more information, please see Policy 403-1103 - Pharmacy Authorization Request Review Process and Policy 403-1128 - Other Non-Formulary Drugs. When requesting a prior authorization for brand name drugs that have generic equivalents available, a MedWatch Form to the Food and Drug Administration (FDA) may be required. For additional information, please see Policy 403-1112 – Therapeutic Equivalence of Generic Drugs.

Prior authorization requests, including formulary exception and step therapy exception requests, must be submitted to MedImpact, not to the Alliance.

If faxed or mailed, prior authorization requests must be submitted on the Prescription Drug Prior Authorization or Step Therapy Exception Request Form (California Form 61-211). Submissions on other forms will not be accepted.

Submitting a Prior Authorization

PA requests must be submitted to MedImpact via the following methods:

Fax: 858-790-7100.
MedImpact ePA Program.
United States (US) Mail:

MedImpact Healthcare Systems, Inc.

10181 Scripps Gateway Court

San Diego, CA 92131

Additional information on ePA Program is available on the MedImpact website or by calling MedImpact at 800-788-2949.

After Hours Access and Emergency Supply

24-hour access is provided by any 24-hour pharmacy that contracts with the Alliance’s Pharmacy Benefit Manager (PBM), MedImpact. Currently, access to 24-hour pharmacies is available in Santa Cruz County (Freedom) and Monterey County (Salinas and Seaside). To find a pharmacy, search in MedImpact's Pharmacy Directory.

MedImpact is authorized to enter an override for a five-day emergency supply of any medication if the pharmacy states that it is for an emergency. The Alliance will receive and retrospectively review a report of all emergency overrides placed by MedImpact. MedImpact can be reached at 800-788-2949.

MedImpact Direct Specialty

The Alliance has a specialty pharmacy network called MedImpact Direct Specialty. The specialty drugs are required to be filled at a pharmacy in the MedImpact Direct Specialty network. These specialty drugs are shown on the formulary with an “SP” symbol.

Prescription referrals for specialty medications need to be sent to MedImpact Direct Specialty. MedImpact Direct Specialty will send referrals, along with the member’s benefit and eligibility information, to a network specialty pharmacy.

How to Submit Specialty Referrals

Fax the MedImpact Direct Specialty Referral Form (which can be downloaded from the MedImpact website) and a copy of the patient's insurance card and lab work, if appropriate, to 888-807-5716.

For any questions regarding MedImpact Direct Specialty, visit the MedImpact Home Delivery Page or call 877-391-1103 (Monday through Friday, 5 a.m. to 5 p.m.).

Mail Order Pharmacies

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