Pharmacy Benefits

Find information on pharmacy copays at retail pharmacies and for mail service prescriptions, as well as the most recent updates to your pharmacy benefits and important pharmacy resources.

Switching to Blue Shield from another health plan?

Here are some helpful steps for new members:
  • Step 1:  Review your prescription drug benefit and copay information based on your plan type.

  • Step 2:  Review the Blue Shield Plus Drug Formulary (PDF, 1.1MB), a list of preferred generic and brand-name medications that are covered under your Blue Shield prescription drug benefits on copayment tiers 1 and 2. Check to see if your medication is listed in the formulary because it may differ from your former health plan's formulary. To help keep your out-of-pocket costs down, ask your doctor to prescribe generic drugs when available and right for you, or formulary brand-name drugs covered on Tier 2 when a generic is not available.

  • Step 3:  If you are receiving mail service prescriptions, make sure to refill your prescription prior to the change in coverage so that you have a supply on hand. To continue receiving medication refills through mail service, contact Blue Shield's prescription mail service, PrimeMail®, to start the prescription transfer process. Note: For maintenance medications (PDF, 169KB), your copay for refills after the first 90 days will increase. The Maintenance Rx Medication benefit optimizes your copay by using PrimeMail. Make sure to transfer your prescription before your copay increases at a retail pharmacy.

  • Step 4:  If you are receiving prescriptions from a specialty pharmacy not in our specialty pharmacy network (CVS Caremark or Walgreens Specialty), make sure to refill your prescription prior to the change in coverage so that you have a supply on hand. To continue to receive medication refills for a specialty drug, contact one of Blue Shield's network specialty pharmacies to start the prescription transfer process.  

  • Step 5:  You or your doctor may request prior authorization from Blue Shield if needed. Select drugs require a physician to provide medical information to Blue Shield to determine coverage. The Plus Drug Formulary (PDF, 1.1MB) provides information about which drugs require prior authorization for coverage and how to submit a request. 

In this section

NetValue HMO, Access+ HMO and EPO Drug Copays

Find drug copay information for HMO and EPO plans for CalPERS members.

Pharmacy Benefits Changes

Read the pharmacy benefits changes to the Blue Shield CalPERS healthcare plans beginning January 1, 2012.

Pharmacy Resources

Access our drug fromulary, check drug interactions, ask a pharmacist a question, find a pharmacy and more.