Skip to main content
CalPERS home
CalPERS Pharmacy
Pharmacy benefits
Prescription drug benefits are an important part of your Blue Shield health plan. Understanding your pharmacy benefits can help you save money.

  • Convenient access to an extensive pharmacy network including Safeway/Vons, Costco and CVS (including CVS Pharmacy® in Target stores).
  • 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.
  • 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.
  • Starting January 1, 2024, Access+ HMO and Blue Shield EPO plan members have transitioned to Blue Shield Value Drug Formulary, which will help members select and use the most cost-effective drugs.

Access+ HMO plan

2024 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
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
2024 annual out-of-pocket maximum
Member: $7,600 Family: $15,200
Member: $7,950 Family: $15,900
Member: $7,950
Family: $15,900
2024 mail-service annual out-of-pocket maximum
N/A
N/A
$1,000 member‡

Trio HMO plan

2024 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
2024 annual out-of-pocket maximum
Member: $7,600 Family: $15,200
Member: $7,950 Family: $15,900
Member: $7,950
Family: $15,900
2024 mail-service annual out-of-pocket maximum
N/A
N/A
$1,000 member¶

Blue Shield EPO plan

2024 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
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
2024 annual out-of-pocket maximum
Member: $7,600 Family: $15,200
Member: $7,950 Family: $15,900
Member: $7,950
Family: $15,900
2024 mail-service annual out-of-pocket maximum
N/A
N/A
$1,000 member‡

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.