Pharmacy networks FAQs

Members who have this benefit have the option of obtaining up to a 90-day supply of covered maintenance drugs through our mail service pharmacy, CVS Caremark®. Maintenance drugs are those drugs taken on an ongoing, regular basis to maintain health.

For new prescriptions, please allow 10 to 14 business days to receive your covered maintenance medications. For refill prescriptions, please allow 5 to 8 business days to receive refills of your covered maintenance medications.

Note: We recommend you have, at minimum, two weeks of medication on hand before ordering a new prescription through the mail service pharmacy.

Prescription fills may be delayed due to incomplete or illegible prescriptions, prescription drug manufacturer backorders, and prescription drugs that require prior authorization for medical necessity. If a drug prior authorization is required, CVS Caremark will return the original prescription along with a letter containing detailed instructions about how to obtain a drug prior authorization approval.

If your doctor indicated refills on your prescription, then you can order a refill of that prescription through the mail service pharmacy when three-quarters of the medication has been taken.

A specialty drug is a medication used to treat complex or chronic conditions that usually requires close patient monitoring. Specialty drugs may be self-administered by injection or inhalation, orally or topically. These drugs may also require special handling and have limited prescribing or limited pharmacy availability. A complete list of specialty drugs is available on the Drug formulary page.

Most Blue Shield members are required to obtain covered specialty drugs through our Network Specialty Pharmacies (check your Evidence of Coverage to see the days’ supply allowed by your plan). To fill specialty drugs, members should contact one of Blue Shield’s Network Specialty Pharmacies.
Blue Shield Network Specialty Pharmacies deliver specialty drugs via courier to the location of the member’s choice (home, work, or retail location). The specialty pharmacy provides pharmacist consultation 24 hours a day, 7 days a week, and all supplies required for administration of the medication (e.g., needles, syringes, alcohol swabs, sharps containers, etc.), at no additional charge. Medications are always packaged for appropriate handling requirements, such as refrigeration.

Members should allow three to five business days from the time a Network Specialty Pharmacy mails the prescription  to receive specialty drugs. 
  
Note:  You should have at least two weeks of medications on hand before ordering a new prescription through one of the Network Specialty Pharmacies.

Some situations that can delay a prescription from being filled are an incomplete or illegible prescription, incomplete registration with the Network Specialty Pharmacy, prescription drug manufacturer backorders, and prescription drugs that require prior authorization for medical necessity. Most specialty drugs require prior authorization and your Network Specialty Pharmacy can start the request for you.

A complete list of specialty drugs is available on the Drug formulary page.