Pharmacy benefits
Prescription drug benefits are an important part of your Blue Shield health plan. Understanding your pharmacy benefits can help you save money.
- Access to an extensive pharmacy network across the United States, including Albertsons, Costco, CVS Pharmacy, CVS Pharmacy at Target, Safeway, Vons, Walmart, and more!
- Save ~30% with 90-day refills for covered maintenance drugs from select retailers (Costco, CVS, CVS Pharmacy at Target, and Safeway/Vons) or the mail-service pharmacy.
- Estimate the costs of outpatient prescription drugs by using our drug pricing tool.
- In addition to COVID and flu vaccines starting in 2023, retail pharmacies can administer preventive vaccines for CalPERS members including Tdap, shingles, pneumonia, and much more.
- New for 2023 Trio HMO plan members may be eligible to lower their cost share on select medications within the following groups: Asthma & COPD inhalers, cholesterol medications, diabetes medications, migraine medications, and nasal steroids.
Access+ HMO Plan
- Plan Documents
- 2023 Evidence of Coverage
2023 Pharmacy benefits-at-a-glance
| Up to 30-day
supply (participating retail pharmacies) | Up to 90-day
supply (select participating retail pharmacies) | Up to 90-day
supply (mail service) | |
|---|---|---|---|
| Generic | $5 | $10 | $10 |
| Formulary brand | $20 | $40 | $40 |
| Non - formulary brand | $50 | $100 | $100 |
| Specialty | $30 | N/A | N/A |
| Brand name (when generic equivalent is available) | $5
(plus cost difference between generic and brand name)* | $10
(plus cost difference between generic and brand name)* | $10
(plus cost difference between generic and brand name)† |
| Sexual dysfunction drugs | 50% coinsurance | N/A | N/A |
| 2023 annual out-of-pocket maximum | Member: $7,600
Family: $15,200 | Member: $7,600
Family: $15,200 | Member: $7,600
Family: $15,200 |
| 2023 mail-service annual out-of-pocket maximum | N/A | N/A | $1,000 member‡ |
Trio HMO Plan
- Plan Documents
- 2023 Evidence of Coverage
2023 Pharmacy benefits at-a-glance
| Up to 30-day
supply (participating retail pharmacies) | Up to 90-day
supply (select participating retail pharmacies) | Up to 90-day
supply (mail service) | |
|---|---|---|---|
Tier 1 | $5 | $10 | $10 |
Tier 2 | $20 | $40 | $40 |
Tier 3 | $50 | $100 | $100 |
Tier 4 | $30 | $60 | $60 |
Brand name (when generic equivalent is available) | $5
(plus cost difference between generic and brand name)* | $10
(plus cost difference between generic and brand name)* | $10
(plus cost difference between generic and brand name)† |
Sexual dysfunction drugs | 50% coinsurance | N/A | N/A |
2023 annual out-of-pocket maximum | Member: $7,600
Family: $15,200 | Member: $7,600
Family: $15,200 | Member: $7,600
Family: $15,200 |
2023 mail-service annual out-of-pocket maximum | N/A | N/A | $1,000 member¶ |
Blue Shield EPO Plan
- Plan Documents
- 2023 Evidence of Coverage
2023 Pharmacy benefits at-a-glance
| Up to 30-day
supply (participating retail pharmacies) | Up to 90-day
supply (select participating retail pharmacies) | Up to 90-day
supply (mail service) | |
|---|---|---|---|
| Generic | $5 | $10 | $10 |
| Formulary brand | $20 | $40 | $40 |
| Non - formulary brand | $50 | $100 | $100 |
| Specialty | $30 | N/A | N/A |
| Brand name (when generic equivalent is available) | $5
(plus cost difference between generic and brand name* | $10
(plus cost difference between generic and brand name)* | $10
(plus cost difference between generic and brand name)† |
| Sexual dysfunction drugs | 50% coinsurance | N/A | N/A |
| 2023 annual out-of-pocket maximum | Member: $7,600
Family: $15,200 | Member: $7,600
Family: $15,200 | Member: $7,600
Family: $15,200 |
| 2023 mail-service annual out-of-pocket maximum | N/A | N/A | $1,000 member‡ |
Find participating pharmacies
View our drug formulary
- 2023 Formulary links
- 2023 Access+ and EPO Online Drug Formulary
- 2023 Trio Online Drug Formulary
- 2023 Limited Pharmacy Specialty Distribution Drug Plus and Value ListsThese Limited Pharmacy Specialty Distribution Drug Plus and Value Lists apply to Access+, Trio and Blue Shield EPO.
- 2023 Maintenance Medication ListThis Maintenance Medication List applies to Access+, Trio and Blue Shield EPO.
Frequently asked questions
What do I need to fill or refill a prescription at a retail pharmacy?
- Bring your member ID card.
- The pharmacy will need the following numbers on your card to process your prescription(s): RxBIN: 004336; RxPCN :7799333.
How do I get prior authorization for compounded drugs?
- Compounded drugs are mixed by a pharmacy to meet special needs.
- If your doctor feels that a compounded drug may work for you, your provider may call Blue Shield Concierge at (800) 334-5847.
- You may also call Shield Concierge for assistance to begin the process.
- Refer to your Evidence of Coverage (listed above).
How do I get a flu shot and what is the cost?
- Getting a flu shot is a good idea. As a Blue Shield member, you can get a flu shot at no extra cost to you at your doctor's office or any participating retail pharmacy.
* The difference in cost does not accrue towards member out-of-pocket maximum.
† The difference in cost does not accrue towards member out-of-pocket maximum or the $1,000 mail-service out-of-pocket maximum.
‡ Non-formulary and drugs to treat sexual dysfunction do not accumulate towards the mail service out-of-pocket maximum.
¶ Non-Formulary Drugs, Tier 3 Drugs, and drugs to treat sexual dysfunction do not accumulate towards the $1,000 mail service out-of pocket maximum.
† The difference in cost does not accrue towards member out-of-pocket maximum or the $1,000 mail-service out-of-pocket maximum.
‡ Non-formulary and drugs to treat sexual dysfunction do not accumulate towards the mail service out-of-pocket maximum.
¶ Non-Formulary Drugs, Tier 3 Drugs, and drugs to treat sexual dysfunction do not accumulate towards the $1,000 mail service out-of pocket maximum.