Participating Pharmacies

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):

Pharmacies within the 35 CMSP counties

Pharmacies in nearby counties

Drug Formularies

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:

  1. CMSP Primary Care Benefit Drug Formulary
  2. CMSP Standard Benefit Drug Formulary
  3. CMSP Record of Denied Program Eligibility Form (for Standard Benefit only)
  4. 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.

MRFAll medications other than listed belowStandard Medication Request Form
MRF-COXFor COX-2 inhibitorsMedication Request Form for COX-2 Inhibitors
MRF-PPIFor Proton Pump Inhibitors (Aciphex®, Nexium®, Prevacid®, Priolsec®, Protonix®).Medication Request Form for Proton Pump Inhibitors
MRF-FOSRENOLFor Fosrenol and RenagelMedication Request Form for Fosrenol and Renagel
MRF-RCFor Risperdal ConstaMedication Request Form for Risperdal Consta
MRF-HEPCFor Hepatitis C Treatment (Copegus®, Rebetol®, Peg-Intron®).Medication Request Form for Hepatitis C Treatment
MRF-EPOGENFor Epogen®, Procrit®, Aranesp®Medication Request Form for Epogen®, Procrit®, Aranesp®
MRF-ACTHARFor H.P. ACTHARMedication 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.