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!
- Locate a network pharmacy near you by using our Pharmacy Locator.
- Save ~30% with 90-days refills for covered maintenance drugs from the mail-service pharmacy
- Retail pharmacy (90-day supply) now available for Access+ HMO for covered maintenance drugs from select retailers
- Contraceptive coverage available at no cost to members
- Naloxone coverage available at no cost to members
- Your cost share is zero if your prescription is on our Value-Based Tier Drug (VBTD) list which includes select preferred generic and brand-name medications for chronic conditions such as asthma, high blood pressure, high cholesterol, and diabetes
- Estimate the costs of outpatient prescription drugs by using our drug pricing tool.
- For pharmacy resources visit blueshieldca.com/pharmacy.
Access+ HMO Plan
- Plan Document
- Access+ HMO Contact Brochure
2024 Pharmacy benefits-at-a-glance
| Prescription drugs | |
|---|---|
| Retail pharmacy (30-day supply) | $10 per Tier 1 prescription |
| $50 per Tier 2 prescription, applicable to $250 deductible | |
| 50% per Tier 3 prescription, $50 minimum/$200 maximum, applicable to $250 deductible | |
| 30% per Tier 4 prescription, up to $250 max (excluding specialty drugs), applicable to $250 deductible | |
| Network Specialty Pharmacy – 30% per Tier 4 prescription, up to $250 max (includes home self-injectable and specialty drugs) | |
| Retail pharmacy (90-day supply) | $30 per Tier 1 prescription |
| $150 per Tier 2 prescription, applicable to $250 deductible | |
| 50% per Tier 3 prescription, $150 minimum/$600 maximum, applicable to $250 deductible | |
| 30% per Tier 4 prescription, up to $750 max (excluding specialty drugs), applicable to $250 deductible | |
| Mail service (90-day supply) | $20 per Tier 1 prescription |
| $100 per Tier 2 prescription, applicable to $250 deductible | |
| 50% per Tier 3 prescription, $100 minimum/$400 maximum, applicable to $250 deductible | |
| 30% per Tier 4 prescription, up to $500 max (excluding specialty drugs), applicable to $250 deductible | |
Contraceptive Care
NOTE: You can contact OPM if you have difficulty accessing contraceptive coverage or other reproductive healthcare at contraception@opm.gov. Additional information about reproductive rights is available at ReproductiveRights.gov.