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.

Announcements

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. 

View Blue Shield Medicare pharmacy policies and benefits

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
Medi-Cal 004336 77993344 (888) 970-0934
Cal MediConnect 004336 77993322 (888) 970-0933

Drug formularies

​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.

  Prescription drug prior authorization or step therapy exception request form (PDF, 1.4 MB)

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.

CVS Caremark Mail Service Pharmacy
Phone: (866) 346-7200 [TTY: 711]
Website: www.caremark.com/wps/portal

Specialty pharmacies

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.

CVS Specialty pharmacy
Phone:(800) 237-2767 [TTY: 711]
Fax: (800) 323-2445
Website: www.cvsspecialty.com

Got questions?

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.