partner | BLUE SHIELD OF CALIFORNIA
PHARMACY (Rx)
You will automatically be enrolled in the prescription drug plan that is coupled with the medical plan you elected. To keep your costs low, make sure to explore all options with your doctor when being prescribed a medication. Most brand-name drugs have a generic equivalent that is equal in strength, purity and quality. Preventive medications are covered at 100% and are not subject to your deductible or coinsurance.
Blue Shield of California
(855) 599-2650
www.blueshieldca.com
HMO | Retail Copay (30 Day Supply)
- Tier 1 - Typically Generic | $10 Copay
- Tier 2 - Typically Preferred Brand | $30 Copay
- Tier 3 - Typically Non-Preferred Brand | $50 Copay
- Tier 4 – Typically Specialty (brand and generic) Specialty | 20% coinsurance up to $250 copay
Mail Order Copay (90 Day Supply)
- Tier 1 - Typically Generic | $20 Copay
- Tier 2 - Typically Preferred Brand | $60 Copay
- Tier 3 - Typically Non-Preferred Brand | $100 Copay
- Tier 4 – Typically Specialty (brand and generic) Specialty | 20% Coinsurance up to $500 copay
PPO | RETAIL COPAY (30 DAY SUPPLY)
- Tier 1 - Typically Generic | $15 Copay
- Tier 2 - Typically Preferred Brand | $40 copay
- Tier 3 - Typically Non-Preferred Brand | $70 copay
- Tier 4 – Typically Specialty (brand and generic) Specialty | 30% coinsurance up to $250 copay
MAIL ORDER COPAY (90 DAY SUPPLY)
- Tier 1 - Typically Generic | $30 Copay
- Tier 2 - Typically Preferred Brand | $80 Copay
- Tier 3 - Typically Non-Preferred Brand | $140 copay
- Tier 4 – Typically Specialty (brand and generic) Specialty | 30% Coinsurance up to $500 copay
RESOURCE LIBRARY
MANAGE YOUR PHARMACY ONLINE
How to get started with Blue Shield Pharmacy Benefits
1. Visit blueshieldca.com/formulary
a. Enhanced Prescriptions Drug Plus
2. Consider the following before filling a prescription
a. Generic drugs are generally more cost-effective. They have the same active ingredients and are therapeutically equivalent to their associated brand-name drug.
b. Some medications require prior-authorization, and approval can take 24-72 hours. Ask your doctor to submit a prior-authorization request through Blue Shield or log on to blueshieldca.com to submit a request.
GET A MAIL ORDER PRESCRIPTION
Ways to access your Mail Service Pharmacy Online Log in to your Blue Shield member account online at blueshieldca.com/login or through the Blue Shield mobile app to access your mail service account.
Website navigation: In the top toolbar select Be Well, Pharmacy, Pharmacy Networks, and select Mail service pharmacy box. Mobile app navigation: In the left navigation bar select My plan, select RX on the upper right, scroll down and under Pharmacy links, select Mail service prescriptions.
LEARN ABOUT PRIOR AUTHORIZATION
Most prescriptions are filled right away when you take them to the pharmacy. But some drugs need to be reviewed by your health plan before they’re covered. This process is called prior authorization. Prior authorization focuses on drugs that may have a risk of side effects, a risk of harmful effects when taken with other drugs, potential for incorrect use or abuse, better options that may cost you less and work better, and rules for use with certain health conditions.
You can view the list of drugs, details and updates when you log in at Provider authorizations Blue Shield of CA Provider (blueshieldca.com)
NATIONAL DRUG FORMULARY LIST
To keep your costs low, make sure to explore all options with your doctor when being prescribed a medication. Most brand-name drugs have a generic equivalent that is equal in strength, purity and quality. Preventive medications are covered at 100% and are not subject to your deductible or coinsurance.