Welcome to the Pharmacy Resources page, please find all pharmacy related forms here:

Forms & Documents Medication Coverage Policies

Prior Authorization Form
In compliance with CCR Title 28 §1300.67.241, HPSJ will only accept and use Form No. 61-211 for prior authorization requests.

Prior Authorization may be requested by telephone to Utilization Management Department at 209-942-6350, fax to 209-762-4702 (San Joaquin County) or 209-762-4703 (Stanislaus County), mail or electronic submission

HPSJ Pharmacy Cognitive Services Program
The purpose of this program is to reward pharmacists for performing value-added cognitive services beyond the mandatory patient counseling required by State Law. Cognitive services are clinically based interventions carried out for the purpose of improving medication prescribing and use.

Eligibility IVR System:
Member eligibility may be checked by using the Eligibility Interactive Voice Response (IVR) Phone line at 209.942.6303. Verification will require one of the following:

  • Member Social Security number
  • Medi-Cal CIN number (first 9 characters, up to the letter)

Newborns are covered for the month of birth and the following month, provided their mother is an eligible HPSJ Member. Pharmacies may submit claims for the Newborns by using mother’s HPSJ Member ID Number, the mother’s full name, and date of birth. Newborns’ eligibility after one month will be determined by Medi-Cal eligibility requirements.

Drug Information Services
HPSJ provides a Drug Information Service for participating providers with questions regarding uncommon or rare clinical conditions or uses. Requestors will receive a written summary with referenced primary literature support. Please provide as much detail as possible, the question that is to be answered, and the time frame in which the answer would like to be received. Please send your Drug Information questions to: RxQuestions@hpsj.com

Posted on July 17th, 2015 and last modified on May 6th, 2021.