PHP, California

Rachel Sakai
AHF Provider

How to Get Prescription Drugs

Current enrollees, learn about changes to PHP (HMO SNP) for 2019.

 

PHP (HMO SNP) includes a prescription drug (Part D) benefit.  We have contracted with MedImpact to manage the plan’s pharmacy benefit.  MedImpact offers a member portal where PHP members can do drug searches, view current copayment amounts and other pharmacy benefit information, check drug pricing, make detailed formulary (list of covered drugs) searches, and search network pharmacies using a pharmacy locator application.

Go to the member portal.

(By clicking on this link you will be taken to a website that is operated by MedImpact and not PHP.  You will need your member ID number, located on your member ID card, to set up an account on the portal.)

 

Getting prescription drugs filled through the plan is simple.  You can fill your prescription at any network pharmacy.  The plan has contracted with hundreds of pharmacies in your area including the large chain pharmacies like CVS and Walgreens, smaller chain pharmacies like AHF Pharmacy, and independent pharmacies.  (By clicking on the link above, you will be taken to the AHF Pharmacy website.  AHF Pharmacy is operated by the parent company of PHP, AIDS Healthcare Foundation.)

If you happen to need to fill a prescription and you are out of Los Angeles County, you can always go to a nearby chain pharmacy that is part of our network to fill your prescription.  Remember that for the plan to cover your prescription, you must have a network provider write it unless the prescription is in connection with emergency care, or the prescription is in connection with urgently needed care when network providers are not available.

 


You can find a PHP network pharmacy by:


 

PHP uses a formulary, which is a list of drugs the plan covers.  If you are taking or want to take a drug that is not covered by the plan and you want us to cover it, you or your prescribing doctor should ask us for a formulary exception (which is a coverage decision).  If we made a coverage decision on a prescription drug and you or your doctor disagree with it, read how to make an appeal.  If you paid for a prescription drug on your own and you want us to pay our share of the cost of the drug (cover the drug), read about how to ask us to reimburse you for a prescription drug you paid for.

If you are new to PHP and are taking a prescription drug that is not on our formulary, or have been a member and are taking a prescription drug that we are taking off the formulary or are changing how it is covered, you should review our Transition Policy.

All members of PHP are enrolled in the plan’s Medication Therapy Management Program.  This program is especially helpful for members who are taking multiple drugs.  You may opt out of the program if you wish.

Members who are receiving “Extra Help” (low income subsidy) from Medicare to help pay prescription drug costs should be familiar with the “Best Available Evidence” policy.  This policy may apply if you believe PHP has the wrong prescription drug cost sharing amount for you.

Detailed information about how to use the plan’s pharmacy benefit is in Chapters 5 and 6 of the 2018 Evidence of Coverage and 2019 Evidence of Coverage.

For members who are not eligible for “Extra Help” from Medicare, they may be able to get help from the California AIDS Drug Assistance Program (ADAP) for paying for certain HIV drugs.  If you want more information, read about what ADAP covers and how to apply.

If you would like to know the aggregate number of grievances, appeals and exceptions filed with PHP for prior and current year, please contact Member Services.


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