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Your prescription benefits guide

Getting your prescriptions filled is easy. Just follow these steps before heading to your pharmacy.

  • Check our formulary
  • Find out if you need prior authorization
  • Consider generic drugs
  • Fill your prescription

1. Check our formulary

The best thing to do before filling your prescription is to review our formulary to see if your medication is included, and whether prior authorization is needed. Every health plan carrier has a different drug formulary, and you’ll want to make sure that your medications are covered under your Blue Shield pharmacy benefits.

If your prescribed drug is not on our formulary, talk to your doctor about an alternative.

The Blue Shield Drug Formulary is a list of preferred drugs approved by the Blue Shield Pharmacy & Therapeutics Committee. The formulary applies to outpatient prescription drug benefits available through plans underwritten by Blue Shield of California and Blue Shield of California Life & Health Insurance Company (Blue Shield Life).

You can request the Blue Shield formulary by contacting Member Services at (800)443-5005, or TTY at (800)241-1823, or go to the Pharmacy section of blueshieldca.com and click Drug database & Formulary

2. Get prior authorization, if required

When your doctor prescribes certain medications, you’ll need to get prior authorization. You often can see whether a drug requires prior authorization by checking the drug formulary.

How to get prior authorization
Your doctor can call or fax authorization forms to your insurance carrier.

Here are some examples of drugs that may require prior authorization, depending on your pharmacy benefits:

  • Non-formulary drugs
  • Drugs with significant potential for misuse, overuse, or safety concerns
  • Drugs that are limited to a maximum quantity
  • Drugs that are limited to a specified duration of therapy
  • Drugs that are not the recommended first-choice treatment

3. Consider generic drugs

A smart way to save money is to choose or request generic drugs. You can do this by making sure that your doctor prescribes generic drugs when they are available. Your pharmacist can also tell you if a generic alternative exists for your brand-name prescription.

Brand vs. generic: what’s the difference?
A brand-name drug is a patented medication available through one manufacturer. Many brand-name drugs that have no generic equivalent are included our formulary.

When a generic version is available, the main difference between the generic equivalent and brand-name versions of the same drug is the price – brand-name drugs generally cost much more. Therefore, using a generic instead of a brand-name drug is one the easiest ways to reduce your prescription costs. Most health plans provide a lower copayment for generic drugs, compared with brand-name drugs.

To save money by choosing generics over brand-name drugs, you can:

  • Ask your doctor to prescribe generic drugs when they’re available and appropriate for your medical condition
  • Find out if a generic exists for your brand-name prescription
  • Ask your pharmacist if a generic exists for your brand-name drug

4. Fill your prescription

To fill your prescriptions, simply present your health plan ID card with your prescription at any retail network pharmacy to receive your medication. If you take maintenance medications, you may be able to fill those prescriptions at the mail service pharmacy; if you take injectable medications you administer at home, you can fill those prescriptions at specialty pharmacies.

Your Rx online tools and resources

To help you make informed decisions about your health and medications, consult your doctor or even web resources provided by your health plan.

Drug formulary online

Find a pharmacy

Ask the Pharmacist

Drug Interaction Checker

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We'll respond within 30 minutes Monday to Friday, 8 a.m. to 5:30 p.m. PST, or the next business day for requests made at all other times.

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