Pharmacy and Therapeutics Committee
The Pharmacy and Therapeutics Committee comprises a multidisciplinary team that meets quarterly to review the Medication Formulary and evaluate the quality of pharmaceutical care our Blue Shield Promise members receive. In addition to maintaining the formulary, the Pharmacy Department manages prior authorizations. This provides a process for physicians and pharmacies to submit requests for medications not currently included in the formulary.
Medicare contract moving to Blue Shield of California
Effective January 1, 2021, the Blue Shield of California Promise Health Plan contract with Medicare has been transferred to Blue Shield of California, which manages our Medicare Advantage pharmacy program.
Medi-Cal Rx launch postponed
Department of Health Care Services (DHCS) has announced the extended delay of the transition of Medi-Cal pharmacy benefit management to the state-run Medi-Cal Rx program. Blue Shield Promise will continue to support Medi-Cal pharmacy benefits until further notice.
Pharmacy claims to be processed by CVS Health
Effective January 1, 2021, Blue Shield Promise pharmacy claims will be processed by CVS Health (CVSH). Please refer to the table below for bank identification number (BIN) and processor control number (PCN) information. For assistance with processing Blue Shield Promise claims, please refer to the Pharmacy Help Desk telephone numbers.
|Plan type||BIN||PCN||CVSH Pharmacy Help Desk|
|Cal MediConnect||004336||77993322||(888) 970-0933|
- Medi-Cal Formulary
- Cal MediConnect Formulary
- Blue Shield Medicare formulary
- 2020 archived formulary changes
Medi-Cal formulary changes
Formulary changes for 1st QTR 2021 (PDF, 97 KB)
Cal MediConnect formulary changes
Formulary changes for 1st QTR 2021 (PDF, 110 KB)
Prescription drug prior authorization form
This form is for participating physicians and pharmacies to obtain medications that are not on the Formulary or require prior authorization.
Additional pharmacy services
Mail service pharmacy
Your patients can have their maintenance medications delivered to their home or office through CVS Caremark Mail Service Pharmacy with no charge for shipping or delivery.
All our network specialty pharmacies, including CVS Specialty pharmacy, are available to all Blue Shield Promise Cal MediConnect members. Physicians may call or fax their patient’s prescription to any specialty pharmacy in our network.
For any questions regarding prescriptions or our drug formularies, please call Provider Services:
Phone: (800) 468-9935, 6 a.m. to 6:30 p.m., Monday through Friday.