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Drug Benefits

Prescription drugs are an essential health benefit and are included in your medical coverage. You can obtain prescription drugs from pharmacies contracted with SummaCare located throughout the service area. You can save money on prescription copays by ordering maintenance drugs through our mail order pharmacy.

Personal Prescription Coverage Information

Log in to review your prescription copay information, mail service details and your prescription history.

Find Your Drug

SummaCare’s partnership with our pharmacy benefit manager provides quality pharmacy benefits to our members. All SummaCare plans include comprehensive prescription drug benefits.

Search for drug using our Find Your Drug tool or view a formulary below.;

For questions about your prescription drug coverage, please contact SummaCare at 800.996.8701.

Find Your Pharmacy

Learn what pharmacies are in our network and search by using our Find Your Pharmacy tool.

Mail Order Pharmacy 

Save money on prescription copays by ordering your maintenance drugs through one of our partner mail service pharmacies listed below.


AcariaHealth Specialty Drug Pharmacy

Certain drugs need to be filled at a specialty pharmacy because they require special handling, are expensive and/or require special monitoring of the patient receiving the drug. Learn more about AcariaHealth Specialty Pharmacy or download the fax form.

Brand Name Drugs vs. Generic Drugs

Our outpatient prescription drug benefit is a generic-based program. You will receive a generic drug unless no generic equivalent exists or the prescribing physician indicates that there cannot be a generic substitute for a specific brand name product by indicating Dispense As Written (DAW) on the prescription. There are a few exceptions to this program, where SummaCare covers a brand drug in place of the generic equivalent drug.

Brand Name Drugs

Drugs that are marketed under a proprietary, trademark-protected name. Brand name drugs are patented and can only be sold by the company with the patent.

Generic Drugs

Drugs that are equivalent of brand name drugs in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. All generic drugs approved by FDA have the same high quality, strength, purity and stability as brand name drugs.

Understanding Prior Authorization

Some medications require prior authorization before they can be filled by a pharmacy. This means your physician needs to complete a Medication Request form including appropriate medical information and submit it as directed so proper assessment can be made of the need for the prescription. 

Your prescriber can request a prior authorization. The Medication Request Form can be completed by your physician and faxed to 858.790.7100. Your physician may also initiate a prior authorization request over the phone by contacting the MedImpact Help Desk at 800.788.2949.


If your drug is not included in the formulary (list of covered drugs), you can ask SummaCare to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make.

  • You can ask us to cover a drug even if it is not on our formulary. If approved, this drug will be covered at a predetermined cost-sharing level.
  • You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs, SummaCare limits the amount of the drug that we will cover. If your drug has a quantity limit, you can ask us to waive the limit and cover a greater amount.
  • You or your prescriber can request an exception. The Medication Request Form can be completed by you or your physician and faxed to 858.790.7100. You or your physician may also initiate an exception request over the phone by contacting the MedImpact Help Desk at 800.788.2949.

Pharmacy Claim Reimbursement

If you paid out-of-pocket for your prescription drugs and would like to request reimbursement, please complete the Commercial Prescription Drug Claim Form and send it, along with the appropriate prescription receipts/labels to:

MedImpact Healthcare Systems, Inc.
PO Box 509098
San Diego, CA 92150-9098

Fax: 858.549.1569

Questions?  We are here to help.

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