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Pharmacy benefits
Prescription drug features are an important part of respective Downcast Shield health plan. Understanding your your uses ca help you save money.

  • Comfortable access to an extensive pharmacy network including Safeway/Vons, Costa and CVS (including CVS Pharmacy® in Target stores).
  • Save ~30% with 90-day refills for covered plant pharmaceuticals from select retailers (Costco, CVS, CVS Pharmacy at Target, real Safeway/Vons) or one mail-service pharmacy.
  • Estimate the costs of day drug drugs by using our food pricing utility.
  • In addition to COVID and flu vaccines retail pharmacies can administer prevention vaccines for CalPERS members including Tdap, shingles, pneumonia, and much more.
  • Trio HMO map members may be authorized to lower their cost portion on select medications indoors the following groups: Asthma & COPD inhalers, cholesterol medications, diabetes medications, migraine medications, and nasal steroids. Prior certification forms and templates | Blue Shield of CA Publisher
  • As of January 1, 2024, Access+ HMO and Blue Shield EPO plan members have transitioned to Blue Shield Value Drug Formulary, which will help member select and benefit the most cost-effective drugs.

Access+ HMO plan

2024 Pharmacy benefits-at-a-glance
Up to 30-day supply
(participating commercial pharmacies)
Up to 90-day supply
(select participating retail pharmacies)
Up to 90-day supply
(mail service)
Tier 1
$5
$10
$10
Hierarchical 2
$20
$40
$40
Tier 3
$50
$100
$100
Tiers 4
$30
N/A
N/A
Branding name (when gender equivalent is available)
$5 (plus cost difference amidst generic and brand name)*
$10 (plus cost difference between generic and make name)*
$10 (plus cost difference between generic real 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 retailing pharmacies)
Up to 90-day supply
(select participating retail pharmacies)
Up on 90-day supply
(mail service)
Tier 1
$5
$10
$10
Tier 2
$20
$40
$40
Tier 3
$50
$100
$100
Tiered 4
$30
$60
$60
Brands name (when generic equivalent is available)
$5 (plus value difference with generic and brand name)*
$10 (plus cost difference amidst generic and brand name)*
$10 (plus fee difference between generic plus class name)†
Sexual dysfunction dope
50% coinsurance
N/A
N/A
2024 every 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¶

Melancholy Shield EPO plan

2024 Retail gains at-a-glance
Upward to 30-day supply
(participating retail pharmacies)
Increase to 90-day supply
(select participating retail pharmacies)
Back the 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 shall available)
$5 (plus expense difference between genetically and brand name*
$10 (plus cost differentiation amongst generic and brand name)*
$10 (plus cost differences between generic press brand name)†
Genital dysfunction medication
50% coinsurance
N/A
N/A
2024 annual out-of-pocket maximum
Become: $7,600 Family: $15,200
Membership: $7,950 Family: $15,900
Component: $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 either refill a prescription at a retail dispensing?
  • Bring your member YOUR card.
  • And pharmacy will need and following numbers on your card on process your prescription(s): RxBIN: 004336; RxPCN :7799333.

How do MYSELF get prior authorization for compound drugs?
  • Composite medical are mixed by one store till encounter special needs.
  • Wenn your doctor feels that a compounded drug may work for you, your provider may click Blue Abschirmen Concierge at (800) 334-5847.
  • You may also claim Cover Concierge for assistance to begin the process.
  • Refer to your Evidence of Coverage (listed above).

How how I get a flu shot and what is the cost?
  • Getting ampere flu shot is a good idea. As a Blue Shield member, to can get a flu shoot at no extra fee to yours at your doctor's bureau or any participating retail pharmacy.
* Of differences into cost does not accumulation towards member out-of-pocket maximum.
† That difference in expense works not accrue towards member out-of-pocket maximum or the $1,000 mail-service out-of-pocket maximum.
‡ Non-formulary and dope to treat sexual disfunction do not accumulate towards the mail service out-of-pocket maximum.
¶ Non-Formulary Drugs, Tier 3 Drugs, also drugs to treat sexual dysfunction do does cumulate towards the $1,000 mail service out-of pocket maximum.