This section of our website is dedicated to providing Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) providers and members with our pharmacy policies and procedures.
Aug 14th, 2025 PH04 Pharmacy Therapeutics Committee - English Aug 14th, 2025 PH05 Prior Authorizations - English Aug 14th, 2025 PH05 Prior Authorizations - English - LARGE PRINT Aug 14th, 2025 PH05 Prior Authorizations - Spanish Aug 14th, 2025 PH05 Prior Authorizations - Khmer Aug 14th, 2025 PH05 Prior Authorizations - Vietnamese Aug 14th, 2025 PH08 Managed Drug Limitations - English Aug 14th, 2025 PH09 Step Therapy - English Aug 14th, 2025 PH10 Dispensing of Off-Label Prescriptions - English Aug 14th, 2025 PH11 Therapeutic Interchange - English Aug 14th, 2025 PH14 Pharmaceutical Safe Use Monitoring of Physician Administered Drugs - English Aug 14th, 2025 PH17 Member Communication - English Aug 14th, 2025 PH18 Practitioner Communication - English Aug 14th, 2025 PH19 Nutritional Supplements for Medical Conditions - English Aug 14th, 2025 PH21 Drug Utilization Review - English Aug 14th, 2025 PH23 Submission of Pharmacy Benefit Prior Authorization & Claims - English Aug 14th, 2025 PH23 Submission of Pharmacy Benefit Prior Authorization & Claims - English - LARGE PRINT Aug 14th, 2025 PH23 Submission of Pharmacy Benefit Prior Authorization & Claims - Spanish Aug 14th, 2025 PH23 Submission of Pharmacy Benefit Prior Authorization & Claims - Khmer Aug 14th, 2025 PH23 Submission of Pharmacy Benefit Prior Authorization & Claims - Vietnamese Aug 14th, 2025 PH25 Pain Medication Requests for the Terminally Ill - English Aug 14th, 2025 PH30 Medical vs. Pharmacy Benefit - English Aug 14th, 2025 PH30 Medical vs. Pharmacy Benefit - English - LARGE PRINT Aug 14th, 2025 PH30 Medical vs. Pharmacy Benefit - Spanish Aug 14th, 2025 PH30 Medical vs. Pharmacy Benefit - Khmer Aug 14th, 2025 PH30 Medical vs. Pharmacy Benefit - Vietnamese Aug 14th, 2025 PH32-Non-Opioid-Pain-Management - English Aug 14th, 2025 PH32-Non-Opioid-Pain-Management - Spanish Aug 14th, 2025 PH33 Pharmacy Services - English - LARGE PRINT Aug 14th, 2025 PH33 Pharmacy Services - Spanish Aug 14th, 2025 PH33 Pharmacy Services - Khmer Aug 14th, 2025 PH33 Pharmacy Services - Vietnamese