Pharmacy

Filling Your Prescription

Prescription drug coverage for both Basic and Standard Options covers approved maintenance (long-term) and short-term medications. Depending on your plan, this applies to prescriptions filled at your local pharmacy, dispensed directly from your doctor or hospital's outpatient department, or (Standard Option only) ordered through the Mail Service Pharmacy Program.

Mail Service Pharmacy Program

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 21-day supply) of your maintenance medications delivered directly to your door.

Simply submit your prescription in the postage-paid envelope with your order form along with the appropriate copayment to Caremark, P.O. Box 1590, Pittsburgh, PA 15230-9607. To determine your appropriate copayment, please refer here.

You may download a mail order prescription form below. Please call 1-800-262-7890 with any questions about your copayment or the mail order prescription form. A customer service representative will be able to assist you.

Mail Service Pharmacy Program website for refills

If the cost of your prescription is less than your copayment, you pay only the cost of your prescription. The Mail Service Pharmacy Program will charge you the lesser of the prescription cost or copayment when you place your order.

When it is time to refill your prescription, you can go to the Mail Service Pharmacy Program website to order and have your refills mailed directly to you.

Your medication will arrive at your home with a specialized member package insert that contains full details about your specific medication and its use. Allow up to two weeks for delivery.

If you have further questions, please call customer care at 1-800-262-7890 24 hours a day, 7 days a week. A registered pharmacist is also available for emergency consultations 24 hours a day, 7 days a week, by calling 1-800-262-7890.

Network retail pharmacies

To fill your prescription at one of the participating network retail pharmacies, just show your ID card when submitting your prescription. There are no deductibles to meet and depending on your plan, you pay only the appropriate coinsurance or copayment amount. It's that simple.

The Pharmacy Network consists of over 60,000 network pharmacies nationwide. To locate a network pharmacy, call 1-800-624-5060 or visit the program’s pharmacy finder . When calling, follow the instructions to hear the most up-to-date listing of network pharmacies in your area. This service is available 24 hours a day, 7 days a week. 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.

Out-Of-Network Pharmacies

If you have Standard Option, you may still purchase your prescription drugs and supplies from out-of-network pharmacies. You will be asked to pay the full amount for these items and then file a Retail Prescription Drug Claim form for reimbursement.

You can download a Retail Prescription Drug Claim form below or obtain a claim form by calling 1-800-624-5060. Basic Option members must use Network retail pharmacies.

Retail Prescription Drug Claim form [PDF 175 KB]



To file a claim for reimbursement from an out-of-network pharmacy:

  1. Pay the full price for the prescription.

  2. Get an itemized bill. It should include the pharmacy's name and address, patient's name, prescription number, date filled, name of drug or supply, strength, quantity, dosage and charge for each medicine or supply.

  3. Ask your pharmacist to help you fill out the Pharmacy Information and Prescription Information sections of the Retail Prescription Drug Claim form.

  4. Complete the Enrollee Information and Patient Information sections of the claim form and sign the bottom.

  5. 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, you will be reimbursed up to 55% of the drug's Average Wholesale Price (AWP) for covered medicines and supplies purchased at an out-of-network pharmacy.

Hospital outpatient pharmacies

Most hospital outpatient pharmacies are out-of-network pharmacies. If you have a bill from the hospital outpatient department with charges only for prescription drugs and covered supplies, we will process the claim through the Retail Pharmacy Program. You need to pay for your items and then file a Retail Prescription Drug Claim form. Include the itemized bill from the hospital with your claim to the Retail Pharmacy Program.

If the outpatient hospital bill includes charges for medicines or supplies as part of expenses for medical treatment, your local plan will process the claim. Most hospitals will file these outpatient charges for you. If the hospital does not file the claim for you, fill out a Service Benefit Plan Health Benefits Claim form, attach your itemized hospital bill, and send the claim to your local Blue Cross and Blue Shield Plan.

Remember, although you can purchase your covered drugs and supplies at an out-of-network pharmacy, you will receive an increased level of benefits and experience greater convenience when you use the Mail Service Pharmacy Program or a network pharmacy.

Long-Term Care Pharmacy Network

The Long-Term Care Pharmacy Network is comprised of pharmacies that service members residing in nursing homes and nursing facilities. These pharmacies are not listed in the network listing. To find out if the pharmacy serving a particular nursing home you're interested in is in the network, call 1-800-624-5060 and speak to a Customer Care Representative.

Other pharmacy providers

If you receive your covered prescription drugs and supplies from providers other than retail or mail pharmacy providers, such as a physician or government health center, you will need to pay for your items and file a Service Benefit Plan Health Benefits Claim form for reimbursement.

To do this, be sure to get an itemized bill and submit it with a completed claim form to your local Blue Cross and Blue Shield Plan.

For medicines and supplies dispensed from these providers, your coinsurance applies to covered charges.

Overseas prescription benefits

Medicines purchased overseas must be equivalent to medicines that require a prescription according to United States federal law. To file a claim for covered medicines and supplies you purchase from pharmacies outside of the United States and Puerto Rico, send a completed Retail Prescription Drug Overseas Claim form, along with the itemized pharmacy receipts or bills to:

Blue Cross and Blue Shield
Service Benefit Plan
Retail Pharmacy Program
P.O. Box 52057
Phoenix, AZ 85072-2057

We will provide translation and conversion services for your overseas claims. You may obtain claim forms for your drug purchases by writing to the above address, by calling 1-888-999-9862 or downloading a copy below:

Retail Prescription Drug Overseas Claim form [PDF 176 KB]

Page last updated: January 10, 2014

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