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Prescription drug benefits information

Learn more about your Blue Shield Promise Medicare pharmacy benefits and how to use them.

Steps to getting started

Get a prescription

Before you go to a pharmacy, you will need to get a prescription from your doctor or transfer your existing prescriptions to a pharmacy of your choice. Please refer to your plan formulary, which explains which drugs are covered, so you can discuss medication options with your doctor.

Get a 90-day supply

Your Blue Shield Promise Medicare plan covers a 90-day supply of your maintenance medications at all network pharmacies (including the CVS Caremark Mail Service Pharmacy). Maintenance drugs are those prescribed to treat a chronic or long-term medical condition, such as asthma, diabetes, high blood pressure, or high cholesterol, and are taken on an ongoing, regular basis to maintain health. Ask your doctor for a 90-day supply prescription.

Note: Tier 5 drugs and opioids are only available for a 30-day supply.

Fill your prescription

You have the choice of filling your prescriptions at a network retail pharmacy or through our mail service pharmacy.

Using a network retail pharmacy

The Blue Shield Promise pharmacy network includes chain pharmacies along with other local community pharmacies. Search for a pharmacy in your area using the pharmacy locator or download the most current Pharmacy directory.

Using our network mail service pharmacy

You can have your maintenance medications delivered to your home or office through CVS Caremark Mail Service Pharmacy with no charge for shipping or delivery.

Learn how to sign-up for the program, place orders, and set up auto-refills:
How to use mail service pharmacy, English (PDF, 128 KB)

Download mail service pharmacy order form in your preferred language:
CVS Mail Service order form, English (PDF, 306 KB)
CVS Mail Service order form, Spanish (PDF, 293 KB)

Contact CVS Caremark Mail Service Pharmacy to sign up or if you have questions:
Phone: (866) 346-7200 [TTY: 711]
Website: https://www.caremark.com/wps/portal

Using our network specialty pharmacies

All our network specialty pharmacies are available to all Blue Shield Promise Medicare Part D members. Your physician may call or fax your prescription to any specialty pharmacy in our network, including CVS Specialty pharmacy.

Phone: (800) 237-2767 [TTY: 711], 4:30 a.m. – 6 p.m., Monday through Friday.
Fax: (800) 323-2445
Website: www.cvsspecialty.com

Formulary: drugs in the plan

Use our online formulary search tool to access information on drugs covered by your plan or request a printed copy of the covered drugs list.

Access formulary information

Search 2020 drug formulary

Find a pharmacy

Download our provider and pharmacy directory for your plan or search online.

Find a pharmacy near you

Get your plan's provider and pharmacy directory

Request a provider and pharmacy directory

Mail-order pharmacy

As a Blue Shield of California Promise Health Plan member, you can access our network mail-order delivery program, allowing you to receive up to a 90-day supply of covered maintenance drugs. 

Use our mail-order pharmacy

Medicare Part D coverage determinations and exceptions

If you need a prescription medication that is not in our formulary, we may be able to make an exception and cover the drug. Find more information on the coverage determination and prior authorization processes.

Get information and forms

Medication transition information

Find out what can you do if your medication is not in our formulary or is restricted.

Learn about medication transition process and policies

Medication therapy management

We offer a no-cost medication therapy management program to qualified members who are at a high risk for medication-related problems.

Learn about Medication Therapy Management Program

Utilization management program and quality assurance policies

Our utilization management program encourages appropriate, cost-effective use of Part D medications. To ensure that our members get safe, appropriate care, we have established quality assurance policies and drug utilization reviews.

Learn how we manage Part D drugs utilization

Read our quality assurance policies

Over-the-counter allowance and benefit catalog

As a Blue Shield Promise Medicare Plan member, you have an over-the-counter (OTC) benefit,1 which provides you a set amount each quarter to spend on everyday health and wellness items.

View OTC Items allowance and benefit catalog

Looking for 2019 plans information?

Visit 2019 Medicare plans site

1. Not all benefits listed are available in all plans or Counties. Benefits and copays vary by plan. See your Evidence of Coverage for details.

H5928_19_536A_M Accepted 10012019

Page last updated: 11/1/2019

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Blue Shield of California Promise Health Plan has neither reviewed nor endorsed this information.

Blue Shield of California Promise Health Plan is an independent licensee of the Blue Shield Association. Blue Shield of California Promise Health Plan is a Medicare Advantage HMO plan with a Federal Government contract in California. Enrollment in Blue Shield of California Promise Health Plan depends on contract renewal.

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