Medicare pharmacy network

Blue Shield of California Medicare Plans have two pharmacy network types:

• If you are enrolled in in one of the following plans you have access to all the pharmacies in our network. Your cost share will be the same, regardless of what pharmacy you use:
  • Blue Shield TotalDual Plan (HMO D-SNP) in Orange and San Bernardino counties
  • Blue Shield Inspire (HMO D-SNP) in San Joaquin, Merced, and Stanislaus counties
    
  • Blue Shield TotalDual Plan (HMO D-SNP) in Los Angeles and San Diego counties
• If you are enrolled in any other Blue Shield of California Medicare Advantage or Medicare Prescription Drug Plans, your pharmacy network includes pharmacies that offer standard cost sharing and pharmacies that offer preferred cost sharing. You may go to either, but your cost may be lower at pharmacies that offer preferred cost sharing.

If you want a pharmacy directory mailed to you, please call (855) 203-3874 (TTY: 711) or email MemberSvcs@blueshieldca.com.

Pharmacy locator

Search for a pharmacy in your area. Enter your ZIP code or address, city, and state. The Pharmacy locator search results will display the closest in-network pharmacies. You can also save and/or print your search results for your convenience by selecting download.

If you are enrolled in Blue Shield TotalDual Plan (HMO D-SNP), Blue Shield Inspire (HMO D-SNP) in San Joaquin, Merced, and Stanislaus counties, Blue Shield TotalDual Plan (HMO D-SNP) in Los Angeles and San Diego counties:

Blue Shield Medicare Advantage Prescription Drug and Blue Shield Medicare Prescription Drug Plan Individual and Employer Group plan members:

To identify network pharmacies that offer preferred cost sharing, check that the listing says Preferred in the Pharmacy Type / Additional services column of your search results.
 

You can also download a pharmacy directory:

If you need help selecting a participating pharmacy, or would like to inquire about the most current pharmacy network information, please call customer service at the number on your Member ID card.

Get an extended supply of your prescription

Your Blue Shield Medicare plan covers an extended supply (90 or 100 days, depending on your plan) of your maintenance medication at all network pharmacies, including Amazon Pharmacy. Maintenance medications are those prescribed to treat a chronic or long-term medical condition, such as asthma, diabetes, high blood pressure, or high cholesterol, and are taken on an ongoing, regular basis to maintain health. Ask your doctor for an extended supply prescription. If your plan offers network pharmacies with preferred cost sharing, you may save money if you fill the prescription at a preferred cost-sharing pharmacy, which includes select retail pharmacies and Amazon Pharmacy.
 

Home delivery pharmacy

You can have your maintenance medications delivered to your home or office through Amazon Pharmacy with no charge for shipping or delivery. You can visit Amazon Pharmacy or call Amazon Pharmacy at (856) 208-4665, 24/7 (TTY: 711).

Specialty pharmacies

Specialty pharmacies are available to all Blue Shield of California Medicare Advantage and Medicare Prescription Drug Plan members. Your doctor may call or fax your prescription to any specialty pharmacy in our network, including CVS Specialty^® pharmacy.

 Online: cvsspecialty.com
 Phone: (800) 237-2767
 Fax: (800) 323-2445

Blue Shield of California’s pharmacy network includes limited lower-cost, pharmacies with preferred cost sharing in certain counties within California. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost pharmacies with preferred cost sharing in your area, please call Customer Service number on your ID card, (TTY: 711), 8 a.m. to 8 p.m., seven days a week, or consult the online pharmacy directory at blueshieldca.com/medpharmacy2025

Group Medicare Advantage Only plans

Group Medicare Advantage Only plans do not have Part D benefits with this carrier. Refer to your Part D carrier's website for Part D prescription benefits coverage.

Out of network perscription coverage

As a Blue Shield of California Medicare Advantage or Medicare Prescription Drug Plan member, you must use network providers to get your medical care and services. The only exceptions are:

• Emergencies
• Urgently needed care when a network provider is not available (generally, when you are out of the area)
• Out-of-area dialysis services
• Cases in which Blue Shield of California Medicare health plan authorizes use of out-of-network providers

You are responsible for paying the full cost of services of unauthorized out-of-network services covered.

Please refer to Chapter 3 of your plan's Evidence of Coverage for full information on out-of-network medical coverage.

Using a pharmacy that is not in the Blue Shield of California network

We have a network of pharmacies outside of our service area where you can fill prescriptions. Generally, we only cover drugs filled at an out-of-network pharmacy when you are not able to use a network pharmacy. To help you, we have designated network pharmacies outside of our service area where you can fill your prescriptions as a member of our plan. If you cannot use a network pharmacy, here are the circumstances under which we would cover prescriptions filled at an out-of-network pharmacy:

• If you are unable to get a covered drug in a timely manner within our service area because there are no network pharmacies within a reasonable driving distance that provide 24-hour service
• If you are trying to fill a covered prescription drug that is not regularly stocked at an eligible network retail or home delivery pharmacy (these drugs include orphan drugs, high-cost and unique drugs, or other specialty pharmaceuticals) 
• Some vaccines administered in your physician’s office that are not covered under Medicare Part B and cannot reasonably be obtained at a network pharmacy may be covered under our out-of-network access
• Prescriptions filled at out-of-network pharmacies are limited to a 30-day supply of covered medications

In these situations, please check with Customer Service at the number on your member ID card to locate a network pharmacy near you.

We recommend that you fill all prescriptions prior to traveling out of the area so that you have an adequate supply. If you need assistance with obtaining an adequate supply prior to your departure, please contact Customer Service.

You may pay more for any drugs you get at an out-of-network pharmacy than you would have paid at an in-network pharmacy. We reimburse for out-of-network pharmacy claims at our contracted rates. The difference will be your responsibility.
 

Direct member reimbursement

As an eligible Medicare Part D member, any time you pay out-of-pocket for a prescription that is covered under your pharmacy benefit plan, you can submit a request for reimbursement.

The reimbursement form must be received within three years from the date you paid for the service. This process is called direct member reimbursement or DMR.

Submission of the form is not a guarantee of payment. Reimbursement requests will not be processed without prescription receipts.

If you need help completing the DMR form, please contact your pharmacist or call Customer Service at the number on your member ID card.

DMR form for Medicare members, English (PDF, 239 KB)
DMR form for Medicare members, Español (PDF, 148 KB)

Mail the completed DMR form to:

Claims Processing
1606 Ave. Ponce de Leon
San Juan, PR 00909-4830