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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

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

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

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

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.