Outpatient Prescription Drug Benefits

Sharp Health Plan members may obtain covered outpatient prescription drugs from Sharp Health Plan contracted pharmacies, located throughout San Diego and southern Riverside counties.  Members also have the option of using mail order pharmacy services for maintenance medications. Follow the links below for more information about the outpatient prescription drug benefits available through Sharp Health Plan.

•    Visit our Drug List to find out if your medication is covered by Sharp Health Plan.
•    Use our Pharmacy Search area to find a Sharp Health Plan pharmacy near you.
•    Learn more about Diplomat Specialty Pharmacy.
•    Read the Outpatient Prescription Drug Benefit disclosure document.

Certain specialty medications are provided exclusively by Diplomat Specialty Pharmacy. Specialty medications are drugs that may require specialized delivery and administration on an ongoing basis. They are often for chronic conditions and involve complex care issues that need to be managed. Examples include Xeloda, Temodar, Sensipar, and Zortress.

Always present your member ID card to the pharmacy.  Ask the pharmacy to inform you if something is not going to be covered.  If the drug is covered by Sharp Health Plan, you are responsible only for the applicable copayment, and you will never pay more than the retail price.

Some medications require prior authorization. This means that your doctor must contact Sharp Health Plan in advance to provide the medical reason for prescribing the drug. Upon receiving your doctor’s request for authorization, Sharp Health Plan will evaluate the information submitted and make a decision based on established clinical criteria for that drug.

Sharp Health Plan does not cover a brand-name drug when a generic is available, unless there is a medical reason why the generic cannot be used. The Food and Drug Administration (FDA) applies rigorous standards for identity, strength, quality, purity and potency before approving a generic drug.  Generics are required to have the same active ingredient, strength, dosage form and route of administration as their brand name equivalents.  Therefore, you can feel confident when taking the generic form of your medication.

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