Retail pharmacies under contract with MedImpact Healthcare Systems, Inc. (MedImpact) provide prescription drug services to CMSP members. Terms and conditions for provider participation, including payment rates, are authorized by the Governing Board. For information concerning participation in the CMSP pharmacy network, contact MedImpact at (800) 788-2949.
To fill a prescription, CMSP members need to go to a local pharmacy that participates in MedImpact’s pharmacy network serving CMSP members. CMSP members can contact the MedImpact Customer Service line at (800) 788-2949 to locate a nearby pharmacy or answer other questions regarding their prescription drug benefit. The MedImpact Customer Service help desk is available 24 hours a day. To download a copy of the pharmacy network (updated quarterly):
MedImpact Healthcare Systems, Inc. (MedImpact) administers all CMSP prescription drug benefits provided through retail pharmacies. As approved by the CMSP Governing Board, there are two CMSP prescription drug benefits, the CMSP Primary Care Benefit and the CMSP Standard Benefit. Both of these benefits emphasize the use of generic medications, where available and appropriate, and require prior authorization and other utilization controls for selected medications based upon clinical efficacy, medical necessity and cost. Additional information about the CMSP Prescription Drug Benefits is provided through the following links:
- CMSP Primary Care Benefit Drug Formulary
- CMSP Standard Benefit Drug Formulary
- CMSP Record of Denied Program Eligibility Form (for Standard Benefit only)
- CMSP Request for Formulary Change Form
Medication Request Forms (MRF)
Physicians seeking prior authorization for medications that are not listed on the formulary or are listed with a Prior Authorization (PA) requirement are required to submit a Medication Request Form (MRF) to MedImpact. There are seven different Medication Request Forms. Physicians are notified by MedImpact if their medication request is approved or denied.
Please use the following medication request forms when seeking prior approval for restricted or non-formulary medications. PLEASE NOTE: To identify urgent needs, MRF forms include an URGENT check-off box.
|FORM NUMBER||PURPOSE||FORM TITLE|
|MRF||All medications other than listed below||Standard Medication Request Form|
|MRF-COX||For COX-2 inhibitors||Medication Request Form for COX-2 Inhibitors|
|MRF-PPI||For Proton Pump Inhibitors (Aciphex®, Nexium®, Prevacid®, Priolsec®, Protonix®).||Medication Request Form for Proton Pump Inhibitors|
|MRF-FOSRENOL||For Fosrenol and Renagel||Medication Request Form for Fosrenol and Renagel|
|MRF-RC||For Risperdal Consta||Medication Request Form for Risperdal Consta|
|MRF-HEPC||For Hepatitis C Treatment (Copegus®, Rebetol®, Peg-Intron®).||Medication Request Form for Hepatitis C Treatment|
|MRF-EPOGEN||For Epogen®, Procrit®, Aranesp®||Medication Request Form for Epogen®, Procrit®, Aranesp®|
|MRF-ACTHAR||For H.P. ACTHAR||Medication Request Form for H.P. ACTHAR|
MedImpact Direct Member Reimbursement
The MedImpact Direct Member Reimbursement (DMR) Form is for use when prescription drugs are paid for out-of-pocket by the beneficiary when covered by CMSP. The DMR form is to be submitted directly to MedImpact for reimbursement of pharmacy costs. For assistance in filling out the form, please contact MedImpact’s DMR department at (858) 566-2727.