Pharmacy

Service Benefit Plan members have access to a retail network of more than 60,000 Preferred pharmacies across the country. 

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Standard Option

Standard Option members can use any Preferred or Non-preferred retail pharmacy, Mail Service Pharmacy, and the Specialty Pharmacy to obtain prescriptions. 

Basic Option

Basic Option members must use a Preferred retail pharmacy or the Specialty Pharmacy to obtain prescriptions.

Pharmacy Benefits

As a Blue Cross and Blue Shield Service Benefit Plan member enrolled in Basic or Standard Option, you have several options to obtain the prescription drugs you need. Contact us with questions, or review our list of FAQs.

Retail Pharmacy Program

Basic Option members must use a Preferred retail pharmacy to obtain prescriptions. Standard Option members can use any Preferred or Non-preferred retail pharmacy.

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Specialty Pharmacy Program

The Specialty Pharmacy Program provides personalized pharmacy care and close monitoring to make sure specialty drugs are safe and effective.

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Discount Drug Program

The Discount Drug Program is available to members for specific drugs that are not covered under the regular prescription drug benefit. 

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Formulary

The formulary list is a list of drugs that are considered the preferred treatment for a patient's condition and that can be used as a guide for a doctor when prescribing drugs.

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Prior Approval

For certain prescription drugs, the Service Benefit Plan Pharmacy Program must determine whether the drug is related to a service or condition that is covered under the Service Benefit Plan before benefits can be approved.

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Mail Service Pharmacy Program

The Mail Service Pharmacy Program available to Standard Option members is a convenient way to get drugs you take regularly delivered to your home. 

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Standard Option Generic Incentive Program

Under Standard Option, your cost share may be waived for up to four generic prescription fills if you switch to a generic drug replacement from a brand name prescription.

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Patient-Centered Care (P-Care)

Patient-Centered Care is a complimentary medication-therapy management program available exclusively to Blue Cross and Blue Shield Service Benefit Plan members in which a clinical pharmacist works individually with members over the telephone.

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Patient Safety

The Blue Cross and Blue Shield Service Benefit Plan has a special program to promote patient safety and monitor healthcare quality. The Patient Safety and Quality Monitoring (PSQM) program features a set of closely aligned programs that are designed to promote the safe and appropriate use of drugs.

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Check Drug Costs

Make sure you are getting the best value by checking the cost of your prescription drugs on our retail pharmacy site by accessing the “price quote” feature on the retail program website. 

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