Retail or mail order pharmacy network and drug price check

Scripps Health Plan members have three ways to obtain medications through the Prescription Drug Program:

1. Retail pharmacies

Prescription drugs that you will only take for a short time or that you need right away should be filled at a participating pharmacy through the MedImpact Pharmacy Network. Present your ID card and pay the appropriate copay for up to a 30-day (one-month) supply of your prescription.

2. Choice90 retail pharmacies

Certain long-term and “maintenance” medications (drugs that your physician prescribes for use on a regular basis for chronic conditions such as diabetes, high blood pressure, asthma, ulcers or high cholesterol) may be purchased at select retail Choice90 pharmacies. Present your ID card and pay the appropriate copay for up to a 90-day (three-month) supply of your prescription.

To locate a participating pharmacy, use the MedImpact Pharmacy Locator:

Pharmacy Locator

To check the price of drugs, use the MedImpact Drug Price Check:

Drug Price Check

3. Mail order service

Scripps Health Plan members may receive mail order prescriptions through Scripps Health Ambulatory Pharmacies.

To enroll in this convenient service:

1. Complete the Scripps Health Ambulatory Pharmacy Medication Order Form (PDF, 150 KB)
2. Fax it along with a list of your prescriptions to 619-686-3932

If you have questions about the program or process, call 858-964-1013.

Specialty medications

Specialty mediations are used to treat complex conditions and usually require particular medications for that condition. Specialty medications are more complex and are often used to treat conditions such as cancer, hepatitis C, hemophilia, multiple sclerosis, HIV and rheumatoid arthritis.

Scripps Health Plan members may receive specialty medications through Scripps Outpatient Pharmacy or through MedImpact Direct Specialty.

Your prescribing physician will forward your prescription directly to the specialty pharmacy.

For specialty medication services through Scripps Outpatient Pharmacy, contact:

Scripps Green Outpatient Pharmacy

Phone: 858-964-1101

Fax: 858-554-2544

For specialty medication services through MedImpact Direct Specialty, contact: 

MedImpact Direct Specialty 

8150 S. Kyrene Road, First Floor

Phoenix, AZ 85284

Phone number: 877-391-1103

Fax number: 888-807-5716

Email: specialtyhub@medimpactdirect.com

• MedImpact Direct Specialty Brochure (PDF, 1.9 MB)

Prescription drug formulary

You can view the Scripps Health Plan Prescription Drug Formulary and also check the price of your medications using the MedImpact Member Portal.

• Prescription Drug Formulary (PDF, 7.3 MB)
• Preferred Drug List (PDF, 200 KB)

The Affordable Care Act (ACA) provides in-network preventive benefits with no out-of-pocket cost to you. Preventive services are based on government recommendations. You can view the current Essential Health Benefit zero copay drug list (PDF, 200 KB).

Requesting a Formulary Exception

Medically necessary non-Formulary drugs are covered and subject to higher copayments. Members and their prescribing providers may request an exception to any prior authorization or step therapy requirement by:

• Requesting by phone at 800-788-2949
• Indicating the request for exception on the Pharmacy Prior Authorization form and submitting the form along with any supporting medical documentation to MedImpact by fax at 1-858-790-7100  

Upon receipt of all required supporting information, MedImpact will review and make a decision to approve or deny your request. Decisions for routine requests are issued within 72 hours from the receipt of the complete information. If your provider believes your condition is life-threatening (exigent circumstance), your request will be expedited, and a decision will be issued within 24 hours from the receipt of the information. If a decision is not reached within these timeframes, your request is considered approved. If your request is approved, your health plan shall provide coverage for requests for the duration of the prescription, including refills. If your request is denied, your notice of denial will include information on how to file an appeal.

Standard appeals are resolved within 30 calendar days, and within 72 hours for expedited appeals (for exigent circumstances). The notice will also include information on how to request an external appeal through the Department of Managed Health Care’s Independent Medical Review process. If your request for an outpatient drug has been denied as not being on the formulary, you, your designee or your provider may request that the original exception request and subsequent denial of such request be reviewed by an independent review organization (IRO).

When a Member requests an External Exception Review, all records related to the request are forwarded to an IRO that is contracted with but not part of your health plan. Submitting an External Exception Review does not preclude you from submitting a complaint with the Department of Managed Health Care. You will be notified of the IRO’s decision within 72 hours for standard requests or 24 hours for expedited requests.

Please submit your external exception request to: 

Scripps Health Plan 

Attention: Appeals & Grievances, Pharmacy External Exception Review 

10790 Rancho Bernardo Road, 4S-300 

San Diego, California 92127

Phone: 858-927-5907 TTY: 1-888-515-4065 

Fax: 858-964-3100 

The health plan may not limit or exclude coverage for a drug that was previously approved, if your provider continues to prescribe the drug for your medical condition, provided the drug is appropriately prescribed and is safe and effective for treating your medical condition.

MedImpact contact

For inquiries related to your prescription drug benefits or participating pharmacies, please call MedImpact customer contact center at 844-282-5343.

Hours of operation

24 hours a day, seven days a week.

Mailing address

MedImpact

10181 Scripps Gateway Ct

San Diego, CA 92131

Online help

Have questions about your prescription drug benefits? Visit the Medimpact Member Portal. Through this site and by logging in as a member, you can:

• Locate a participating retail pharmacy
• Locate a participating Choice90 pharmacy
• View formulary and preferred drug listings to assist in determining drug coverage and obtain cost estimates
• View information on pharmacy benefits
• View and print prescription drug history