The Care Management services uses a member/caregiver approach to promote availability of appropriate care and resources while maximizing the member’s quality of life and health care benefits. The assigned Case Manager works directly with the member and the family/caregiver(s) to develop an Individualized Care Plan (ICP) that is focused on increasing access to resources and services that support the member’s health needs.
Complex Case Management (CCM) is provided to members who have experienced a critical event or diagnosis that requires extensive use of resources and requires oversight to navigate the needed delivery of care and services. Case management becomes complex when the illness and/or conditions and complexity are severe and require an intense level of management beyond that of Case Management.
In addition to complex cases with co-morbid conditions and high utilization, the CCM team offers specialty focus areas including:
- Three or more acute hospital admissions per year.
- Two or more emergency department visits in a three-month period.
- Complex medical needs that require close monitoring, including but not limited to transplant, transgender, high-risk OB, high-risk pediatrics.
- Behavioral health conditions, including but not limited to depression, substance abuse, anxiety, autism, severe mental health illness, and maternal mental health.
- Life expectancy of six months or less.
- Complex psychosocial or functional requirements.
Did you know that anyone can make a referral to our Care Management Program. Referrals can be made via:
- Epic: ambulatory order #210
- Email: firstname.lastname@example.org
- Voicemail: 888-399-5678
- Fax: (858) 260-5834
- CM Referral Form (PDF, 58 KB)
Scripps Health Plan provides coverage for all medically necessary outpatient prescription drugs. Scripps Health Plan utilizes a formulary to define preferred drugs and requires prior authorization for all non-preferred drugs. Prescription drugs may only be prescribed by licensed physicians, licensed physician assistants, licensed nurse practitioners, dentists and licensed behavioral health practitioners in accordance with their credentials and licensure. Prescriptions should be written to allow generic substitution whenever possible and signatures on prescriptions should be legible, and electronically submitted when possible.
The Scripps Health Plan Prescription Drug Plan is managed by MedImpact, a trusted Pharmacy Benefits Manager (PBM). For inquiries related to your patient’s pharmacy benefit or prior authorization requirements, please call MedImpact customer contact center at 844-282-5343. MedImpact is available 24 hours a day, 7 days a week.
To locate a participating pharmacy, search the MedImpact Pharmacy Locator.
10181 Scripps Gateway Ct.
San Diego, CA 92131
90-days’ supply of medications may be filled by MedImpact Choice90 network pharmacies or Scripps Outpatient Pharmacies. Information about the mail order program is available through Scripps Outpatient Pharmacies and by using the Scripps Health Ambulatory Pharmacy Medication Order Form (PDF, 150 KB) and fax it along with the prescriptions to 619-686-3932. Call 858-964-1013 if you have any questions.
Specialty medications are used to treat chronic and complex conditions and usually require particular medications for that condition. Specialty medications are more complex and are often used to treat conditions such as cancer, hepatitis C, hemophilia, multiple sclerosis, HIV and rheumatoid arthritis.
Scripps Health Plan members may receive specialty medications through Scripps Outpatient Pharmacy or through MedImpact Direct Specialty.
For specialty medication services through Scripps Outpatient Pharmacy, contact:
Scripps Green Outpatient Pharmacy
For specialty medication services through MedImpact Direct Specialty, contact:
MedImpact Direct Specialty
8150 S. Kyrene Road, First Floor
Phoenix, AZ 85284
Phone number: 877-391-1103
Fax number: 888-807-5716