Pharmacy Benefits
Whether you choose to go to your local pharmacy to get your prescriptions filled or take advantage of the unique opportunity to receive your prescriptions through the mail, your Standard Option benefits will have you covered.
Mail Service Pharmacy
Available to Standard Option members only, the Mail Service Pharmacy Program is a convenient and affordable way to receive the medications you use regularly by mail. For the cost of one copayment, you can have up to a 90-day supply (minimum 22-day supply) of your maintenance medications delivered directly to your door.
Retail Pharmacy (Preferred)
Just show your ID card at one of the 60,000 Preferred network pharmacies. You pay only your share of coinsurance of the Plan Allowance for each prescription or refill and there are no deductibles to meet. It's that easy. You pay your coinsurance and don't have to file a claim!
To locate a Network pharmacy, visit the Provider Directory on this Web site or call 1-800-624-5060. When calling, follow the telephone prompt instructions to hear the most up-to-date listing of Network pharmacies in your area 24 hours a day. Customer Care representatives are also available Monday through Friday, 8 a.m. to 9 p.m. and Saturday from 8 a.m. to 6 p.m. Eastern Time to assist you.
Retail Pharmacy (Non-preferred)
If you have Standard Option, you may also purchase your prescription drugs and supplies from Non-preferred pharmacies. You will have to pay the full amount up front for these items when you purchase them and then file a Retail Prescription Drug claim form for reimbursement. You can easily download the claim form from this Web site or call the Retail Prescription Drug Program and ask to have a claim form mailed to you. You can also photocopy the claim form for future use, if needed
Reimbursement
- Pay the full price for the prescription.
- Get an itemized bill from the out-of-network pharmacy. It should clearly show the following information:
- Name and address of the pharmacy
- Patient's name
- Prescription number
- Date filled
- Name of drug or supply, strength, quantity and dosage
- Amount charged for each medicine or supply
- Ask your pharmacist to help you fill out the Pharmacy Information and Prescription Information sections of the Retail Prescription Drug claim form.
- Fill in the Subscriber Information and Patient Information sections of the claim form. Don't forget to include the member's signature.
- Send the completed claim form and any related pharmacy receipt(s) to:
Blue Cross and Blue Shield Service Benefit Plan
Retail Pharmacy Program
P.O. Box 52057
Phoenix, AZ 85072-2057
When your claim is processed, we will reimburse you up to 55% of the Average Wholesale Price (AWP) for covered medicines and supplies purchased at a Non-preferred pharmacy.
Remember, although you can purchase your covered drugs and supplies at a Non-preferred pharmacy, you will receive an increased level of benefits and experience greater convenience when you use the Mail Service Pharmacy Program or a Preferred retail pharmacy.
Specialty Drug Pharmacy Program
If your physician prescribes a specialty drug that appears on our Service Benefit Plan Specialty Drug List, your physician may order the initial prescription by calling our Specialty Drug Pharmacy Program at 1-888-346-3731 (TDD: 1-877-853-9549), or you may send your prescription to: Specialty Drug Pharmacy Program, CVS Caremark, P.O. Box 1590, Pittsburgh, PA 15230-1590. You will be billed later for the copayment. The Specialty Drug Pharmacy Program will deliver your specialty medication directly to you or your doctor's office in about two weeks. After that, to order refills either call the same number or access our pharmacy site and either charge your copayment to your credit card or have it billed to you later. Allow approximately one week for delivery on refills.
Note: For the most up-to-date listing of covered specialty drugs, call the Specialty Drug Pharmacy Program at 1-888-346-3731 (TDD: 1-877-853-9549) go to our formulary page.
Below is a summary of what you will pay for up to a 90 day supply using Standard Option Pharmacy benefits:
| Preferred Pharmacy Benefit | Non-preferred Pharmacy Benefit | |
|---|---|---|
Mail Service Benefit | Tier 1 (Generic): $15 copayment per fill $10 copayment per fill if you have Medicare Part B $0 copayment for the first 4 fills if switch from selected Brand medications. Learn more here . Tier 2 (Preferred Brand) — $70 copayment Tier 3 (Non-Preferred Brand) —$95 | There is no benefit |
Retail Benefit | Tier 1 (Generic): 20% of Plan allowance 15% if you have Medicare B $0 copayment for the first 4 fills if switch from selected Brand medications. Learn more here . Tier 2 (Preferred Brand ): 30% of the Plan allowance Tier 3 (Non-preferred Brand): 45% of Plan allowance Tier 4 (Specialty): 30% of the Plan allowance when purchased at a Retail Pharmacy | Up to 45% of the Average Wholesale Price (AWP) plus any difference between the AWP and the billed charge, no deductible |
Specialty Drug Pharmacy Program | Tier 4 (Specialty): $80 copayment when purchased through our Specialty Drug Pharmacy Program | Up to 45% of the Average Wholesale Price (AWP) plus any difference between the AWP and the billed charge, no deductible |
Routine Immunizations Available at a Participating Preferred Retail Pharmacies Influenza Vaccine Benefit
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| No cost to you when provided by a Preferred retail pharmacy that participates in our vaccine network and administered in compliance with applicable state law and pharmacy certification requirements |
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Managing medication costs
To learn more about how to fill your prescriptions and make the most of your prescription benefits, visit the Pharmacy section of this Web site. Information about your prescription benefits is also available in your Service Benefit Plan Brochure.
After enrolling in the Service Benefit Plan, you will be able to register with Caremark. Here you will have access to additional features for your pharmacy benefits, such as:
- Calculate the lowest-cost option for your prescription refills.
- View your prescription history.
- Look up drug interactions and side effects.
- Get reliable information on health, nutrition, fitness, and much more.
Page last updated: January 06, 2012