NetValue HMO, Access+ HMO and EPO Drug Copays
Prescriptions at Participating Pharmacies
Blue Shield offers a large pharmacy network that includes chains such as Walgreens, CVS, and Rite Aid, as well as other retail pharmacies. Find a network pharmacy.
Maintenance Drugs After 3 Months of Fill
|$5 generic||$10 generic|
|$20 brand-name||$40 brand-name|
|$50 non-formulary||$100 non-formulary
Prescriptions not to exceed a 30-day supply
|$30 for specialty drugs|
|50% of the contracted rate for drugs to treat sexual dysfunction|
|Prescriptions not to exceed a 30-day supply for short-term or acute illness, and maintenance medication for the first 3 months|
|Brand-name drugs when generic equivalent is available: $5 plus difference in cost between generic drug and brand-name drug.||Brand-name drugs when generic equivalent is available: $5 plus difference in cost between generic drug and brand-name drug.|
Maintenance Medication Rx Benefit: For drugs obtained at a participating pharmacy, after 3 months, the mail service copayment will apply to maintenance drugs for each subsequent 30-day supply. For diabetic supplies, the non-formulary copayment may also apply. Optimize your Rx copay for maintenance medications by using Blue Shield's mail service pharmacy, PrimeMail, after stabilizing your dose.
Maintenance drugs are those prescribed to treat chronic health conditions such as asthma, diabetes, high blood pressure, or high cholesterol, and are taken on an ongoing, regular basis to maintain health. See the list of covered maintenance medications.
Prescriptions Through the Mail
Blue Shield provides access to the mail service drug benefit through PrimeMail®, which offers you the convenience of receiving up to a 90-day supply of covered maintenance drugs delivered to your home or office, with no charge for shipping. PrimeMail pharmacy services also saves you money on maintenance drug prescriptions, as you pay only one-third of the retail pharmacy copayment for the same amount of covered drugs. For example: For a $10 copayment, you can purchase a 30-day supply of generic drugs at your retail pharmacy or a 90-day supply of generic drugs from PrimeMail. (Please see prescription charts above and below for other cost comparisons.)
PrimeMail pharmacy services also save members money on maintenance drug prescriptions, as they pay only one-third of the retail pharmacy copayment for the same amount of covered drugs.
|Mail-Service Prescription Drugs|
|Prescriptions not to exceed 90-day supply for maintenance drugs|
|Brand-name drugs when generic equivalent is available: $10 plus difference in cost between generic drug and brand-name drug|
|$1,000 out-of-pocket annual maximum, excluding non-formulary drugs, drugs for sexual dysfunction and the difference in cost that the member may have paid between a brand-name drug and its generic equivalent|
To receive covered medications from PrimeMail, you must first register online, by phone or by mail to provide the basic information required, such as your name, shipping address, payment method, and drug allergies. Instructions for each registration method are listed below:
Online – Register online by logging into the blueshieldca.com website as a member, selecting Pharmacy, and clicking on the myprimemail.com link under the mail service pharmacy page. If you are a first-time user, you will be brought to the My Account page, where you will be prompted to fill in your information, including address, allergies, and payment options.
If you logged in but did not complete your registration the first time, or if you need to make any changes to your profile, log into blueshieldca.com as a member, select Pharmacy, and click on the myprimemail.com link under the mail service pharmacy page. Then select My Account in the upper right corner of the page, and update your registration.
By phone – Call PrimeMail at (866) 346-7200 or TTY (866) 346-7197. A PrimeMail representative can either mail the Prescription Order Form to you or complete it for you over the phone.
By mail – Print and complete the PrimeMail Order Form by logging into blueshieldca.com, selecting Pharmacy, and then clicking on the myprimemail.com link under the mail service pharmacy page. Once you are logged into myprimemail.com, select Order New. You can choose to complete the form online and then print it, or print out a blank form and complete it by hand. Once you complete the form, simply mail it to:
P.O. Box 27836
Albuquerque, NM 87125-7836
Once you are registered, PrimeMail will need your prescription; this can be sent electronically, or by phone, fax, or mail:
Electronically – Ask your doctor to send an electronic prescription for a 90-day supply to PrimeMail. This is called “e-prescribing” and is the simplest way to send a prescription.
By phone or fax – Request your doctor to submit your prescription for a 90-day supply by phone or fax to PrimeMail.
PrimeMail doctor phone line: (888) 215-3015
PrimeMail doctor fax line: (888) 214-1811
Alternatively, you can ask PrimeMail to contact your doctor directly to obtain a prescription order or to transition an existing prescription from your current retail pharmacy by either:
Calling PrimeMail at (866) 346-7200, or
Logging into your account at blueshieldca.com, selecting Pharmacy, and then clicking on the myprimemail.com link under the mail service pharmacy page. Once you are logged into myprimemail.com, select Transition Prescription from Retail to PrimeMail. After selecting your name from the patient name field, you will see a search screen where you can type in the name of the prescription drug that you want transitioned to PrimeMail, along with the dosage form and strength. PrimeMail will contact your doctor to transition your prescription and obtain approval for a 90-day supply.
By mail – If you already have a written prescription from your doctor for a 90-day supply, you can mail it with your applicable mail service copayment and a copy of your Blue Shield member ID card to the address below. If you plan to mail your registration form, you can simply include your written prescription and copayment with your registration form.
P.O. Box 27836
Albuquerque, NM 87125-7836
Please allow 10 to 14 days to receive your covered maintenance medications through PrimeMail. Once your prescription is on file at PrimeMail, please allow five to eight days to receive refills of your covered medications.
You can check the status of your order and order prescription refills by logging into your account at blueshieldca.com, selecting Pharmacy, and then clicking on myprimemail.com under the mail service pharmacy section, or by calling PrimeMail directly at (866) 346-7200 or TTY (866) 346-7197.
To find out more about your pharmacy copayments and benefits:
Check your Evidence of Coverage (EOC) booklet on the Plan Documents page.
Call Member Services at (800) 334-5847
Log into blueshieldca.com and select My Health Plan section to view your plan summary, benefits, and more.
About Our Drug Formulary
The Blue Shield Drug Formulary is a comprehensive list of preferred generic and brand-name drugs. Drugs in the formulary have been evaluated by Blue Shield’s pharmacy and therapeutics (P&T) committee to ensure they are safe and effective. P&T committee members are physicians and pharmacists in community practice, not employees of Blue Shield. The committee bases its decisions on the medical evidence for a drug’s safety and efficacy, and for how it compares to other drugs covered on our drug formulary.
You can help lower your out-of-pocket prescription drug costs by requesting formulary drugs and generic medications when you see your doctor. Drugs listed on the formulary are usually covered at a lower copayment than non-formulary drugs. To see our drug formulary, visit the Pharmacy Resources page.
Save with Generic Drugs
Using generic drugs instead of brand-name drugs is one of the easiest ways you can reduce your out-of-pocket prescription drug costs.
When a new drug is introduced, it is initially available as a brand-name drug and is produced and sold by the original manufacturer. Once the original manufacturer’s patent expires, other companies can produce generic versions of the brand-name drug. Generic drugs typically cost less than brand-name drugs.
All generic drugs are approved to be safe and effective by the U.S. Food and Drug Administration (FDA). Generics contain the same active ingredients as their brandname counterparts. The FDA requires generic drugs to be the same in dosage, performance, safety, strength, quality, and usage as the brand-name drug. Ask your doctor if a generic drug is right for you.
Ask the Pharmacist
As a member, you have access to a pharmacist with our Ask the Pharmacist program. You can ask questions about your medications via e-mail and receive personal and confidential answers from a clinical pharmacist at the University of California, San Francisco within two business days.