Access+ HMO and EPO Drug Copays
Prescriptions at retail 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.
|Up to a 30-day supply of non-maintenance drugs or the first 3 fills of maintenance drugs|
Up to a 30-day supply of maintenance drugs after the first 3 fills or up to a 90-day supply of maintenance drugs from select retail pharmacies
|$5 generic||$10 generic|
|$20 brand-name||$40 brand-name|
|$50 non-formulary||$100 non-formulary
|$30 for specialty drugs|
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, unless you obtain a 90-day supply from a select pharmacy. For a list of select pharmacies, please visit the Pharmacy Resources page. For diabetic supplies, the non-formulary copayment may also apply.
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 service pharmacy
Blue Shield provides access to the mail service drug benefit through CVS Caremark, 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.
|Up to a 90-day supply of maintenance 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 CVS Caremark, 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 here:
Online – Register online by logging into the www.caremark.com website. Choose the Register Now option.
By phone – Call CVS Caremark at (866) 346-7200 or TTY 711. A CVS Caremark representative can either mail the Prescription Order Form to you or complete it for you over the phone.
By mail – Print and complete the CVS Caremark Order Form by logging into blueshieldca.com, selecting Be Well, clicking Drugs and then the Mail Service Prescriptions option. You can print out a blank form and complete it by hand. Once you complete the form, simply mail it to:
P.O. Box 659541
San Antonio, TX 78265-9541
Once you are registered, CVS Caremark 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 CVS Caremark. 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 CVS Caremark.
CVS Caremark doctor phone line: (800) 378-5697
CVS Caremark doctor fax line: (800) 378-0323
Alternatively, you can ask CVS Caremark to contact your doctor directly to obtain a prescription order or to transition an existing prescription from your current retail pharmacy by either:
Calling CVS Caremark at (866) 346-7200, or
After you register with CVS Caremark, logging into www.caremark.com, selecting Prescriptions, and then selecting Request a New Prescription. After choosing your name from the Whose medication is this? field, you will search for your medication by typing in the name of the prescription drug that you want transitioned to CVS Caremark, along with the dosage form and strength. You will then Add to Cart and answer basic medical questions, before selecting your Prescriber's name, your shipping address and your shipping method. CVS Caremark 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 659541
San Antonio, TX 78265-9541
Please allow 10 to 14 business days to receive your covered maintenance medications through CVS Caremark. Once your prescription is on file at CVS Caremark, please allow five to eight business 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 www.caremark.com, or by calling CVS Caremark directly at (866) 346-7200 or TTY 711.
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 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 doctors 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 in 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.