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Prescription Drug Plan Overview

By enrolling in the Scripps Medical Plan, you are automatically enrolled in the Prescription Drug Program administered by MedImpact. The Prescription Drug Program offers you the flexibility to purchase your medications either at a retail network pharmacy or through the prescription mail order service.

How the Program Works

You have three ways to purchase your medications through the Prescription Drug Program:

MedImpact Retail Pharmacies

Prescription drugs that you take for a short time or need right away, you should have filled at a participating MedImpact pharmacy. Present your ID card and pay the appropriate copay for up to a 30-day (1 month) supply of your prescription. To locate a participating provider, please click here.

Choice90 Retail Pharmacies

Certain long-term and maintenance medications may be obtained at select retail Choice90 pharmacies. Present your ID card and pay the appropriate copay for up to a 90-day (3 month) supply of your prescription. Please visit MedImpact to find a participating Choice90 pharmacy near you.

Mail Order Service

You can receive up to a 90-day supply of prescription drugs that you take on an ongoing or "maintenance" basis (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), mailed to your home through the mail order program. The mail order program is offered through Scripps Ambulatory Pharmacies or MedImpact Direct. To enroll in this convenient service, complete the Scripps Health Ambulatory Pharmacy Medication Order Form and fax it along with your prescriptions to 619-686-3932 or call 858-964-1013 if you have any questions.

For Mail order services log into you account at http://www.medimpact.com, then complete and submit out the order form under the document tab.

The table below highlights the benefits available under each pharmacy option:

Drug Type MedImpact
Retail Pharmacy
(30 day supply)
Choice 90 Pharmacy
Retail Pharmacy
(90 day supply)
Mail Service
Pharmacy
(90 day supply)
Annual Out-of-Pocket Maximum* EPO Plan: $4,150 per person; $8,300 per family

Generic $15 copay $30 copay $30 copay
High Cost Generic
(cost over $50 with relevant alternatives)
$40 copay $100 copay $100 copay
Preferred/Formulary $40 copay $100 copay $100 copay
Non-Preferred/Non-Formulary $70 copay $210 copay $210 copay
Specialty Medications EPO members living or working within San Diego County that have access to Scripps Care Partner and choose to fill specialty medications at retail, 30% coinsurance per prescription ($100 min; $300 max). EPO members living and working outside of San Diego County and are enrolled in the out-of-area plan, 30% coinsurance per prescription ($100 min; $200 max); When filled through the Care Partner program: $0 copay
* Annual out-of-pocket maximum for prescription drugs is separate from Scripps Medical Plan out-of-pocket maximum.

The amount of your copay depends on the type of drug and its inclusion on the formulary/preferred drug list:
  • Generic Drugs

    You pay the lowest copay for generic drugs. These drugs are sold under the drug’s chemical name and contain the same active ingredients and equivalent strength and dosage to the brand-name equivalent.
  • High Cost Generic Drugs

    Generic drugs costing over $50 that have a relevant alternative.
  • Brand Drugs on Formulary/Preferred Drug List

    You pay a lower copay for drugs on the formulary/preferred drug list. If you elect to receive a brand medication when a generic is available, you will pay the price difference between the brand and generic, plus the brand copay.
  • Brand Drugs Not on Formulary/Preferred Drug List

    You pay the highest copay on brand drugs not on the formulary/preferred drug list. If you elect to receive a brand medication when a generic is available, you will pay the price difference between the brand and generic, plus the brand copay.

Save Money on Prescriptions Not Covered by Your Medical Plan

As part of your prescription drug benefit, you automatically participate in the iRx Program™ which allows you to save money on prescription drugs not covered under Scripps Medical Plan. On average, you can save 25 percent (with potential savings as high as 75 percent)* when you use a participating pharmacy for a drug that qualifies for a discount. More than 60,000 participating pharmacies accept the iRx Program™, including most participating MedImpact pharmacies.

How it Works

  • Present your prescription and your Scripps Medical Plan ID card at a participating pharmacy.
  • Savings are automatically applied when the medication prescribed is not covered under Scripps Medical Plan and qualifies for a discount.
  • Prescriptions that qualify for a discount through the iRx Program™ are automatically cross-referenced with your other prescriptions to check for safety issues, such as drug interactions.
  • There are no limits on the number of times the program can be used.
  • You are automatically enrolled as part of your Scripps Medical Plan coverage, and you pay no separate enrollment or maintenance fees.