CareAdvantage Dual Eligible Special Needs Plan (D-SNP) 2024
In general, CareAdvantage only covers prescriptions that are filled by network pharmacies. However, there are certain circumstances under which CareAdvantage will reimburse you for prescriptions filled by out-of-network pharmacies. Quantity limits and restrictions may apply.
For the over-the-counter drugs and vitamins that are covered under Medi-Cal Rx, you can find a network pharmacy in the Medi-Cal Rx Pharmacy Directory at medi-calrx.dhcs.ca.gov. You can also find a pharmacy near you by calling Medi-Cal Rx at 1-800-977-2273 (TTY 800-977-2273 and press 5 or 7-1-1).
Pharmacy Mail Order Benefits
CareAdvantage has partnered with Postal Prescription Services (PPS) to offer mail order pharmacy services at no extra cost. You pay the same copay as you would at your local pharmacy since shipping is free. Most medications arrive at your door no more than seven to ten days.
Getting Mail Order Benefits
PPS can either ask for a new prescription from your provider or call your current pharmacy to move your prescription(s) over. To start the process you can:
- CONTACT PPS BY PHONE: 1-800-552-6694 to create an account.
- SET UP A PPS ACCOUNT ONLINE
- Visit ppsrx.com and select "Create an Account"
- Select "Add a Patient". Note: f you have not filled a prescription with PPS, you will need to select "Request New Patient" and follow the steps to set up your new patient profile.
- Follow instructions to "Add Online Prescription Management" to request first refill.
CareAdvantage Network Pharmacies
The CareAdvantage network includes more than 200 pharmacies in San Mateo County and San Francisco. Outside of these areas, you can fill prescriptions at the following chain pharmacies:
- Costco: 1-800-607-6861
- CVS: 1-800-746-7287
- Lucky: 1-800-692-5710
- Rite Aid: 1-800-748-3243 TTY/TDD: 1-800-821-1833
- Safeway: 1-877-723-3929
- Target: 1-800-440-0680
- Walgreens: 1-800-925-4733
Search for a pharmacy
- Search by pharmacy name, health plan, location or other type of provider
- Click on a pharmacy name in the search results to see additional information
- Search results include links to interactive maps and directions
- Print or save the information for individual pharmacies
- Weekly updates ensure you get the most accurate results
If you pay the full cost of a prescription, CareAdvantage will reimburse you under certain circumstances, such as when you
- Fill a prescription in an emergency situation at a non-network pharmacy
- Need a specialized drug that is not available at a network pharmacy
- Need a drug that is only available, by law, at specific pharmacies
Note that HPSM will not reimburse you for your Part D prescription co-pay.
To Request Reimbursement
Send a copy of your pharmacy receipt to:
Health Plan of San Mateo
Attn: CareAdvantage Unit
801 Gateway Blvd., Suite 100
South San Francisco, CA 94080
Or email a copy of your pharmacy receipt to firstname.lastname@example.org.
For information regarding prescription reimbursement requests for Medi-Cal Rx covered over-the-counter drugs and vitamins, please visit the Medi-Cal Rx website (www.medi-calrx.dhcs.ca.gov). You can also call the Medi-Cal Rx Customer Service Center at 1-800-977-2273.
CareAdvantage Dual Eligible Special Needs Plan (D-SNP) is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Limitations and restrictions may apply. For more information, call the CareAdvantage Unit or read the CareAdvantage D-SNP 2024 Member Handbook.
Benefits and co-pays may change on January 1 of each year.
If you speak other languages other than English, language assistance services, free of charge, are available to you. Call 1-866-880-0606 (TTY: 1-800-735-2929 or dial 7-1-1). ( Download this statement in multiple languages.)
Page updated November 1, 2023