How does the outpatient prescription drug mail service pharmacy benefit work?
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.
Can I fill a new prescription or refill an existing prescription online through the mail service pharmacy?
To receive medications from CVS Caremark, you must first register online, by phone, or by mail to provide basic information such as your name, shipping address, payment method, and drug allergies. See instructions for registration and ordering a new or existing refill.
I submitted a long-term prescription to the mail service pharmacy but only received a 30-day supply. Why?
CVS Caremark, our contracted mail service pharmacy, fills maintenance medications for up to a 90-day supply depending on your pharmacy plan benefit. If your physician writes a prescription quantity of 30 days' supply, the pharmacy will dispense that amount.
What is the approximate turnaround time for mail service pharmacy prescriptions?
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.
What is the benefit of using a mail service pharmacy?
Depending upon your pharmacy benefit plan, you may save money by using our contracted mail service pharmacy, CVS Caremark. CVS Caremark can fill your maintenance medications for up to a 90-day supply, and ship them to the address of your choice.
How soon after the first time a prescription is filled can I refill the prescription through the mail service pharmacy?
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.
What is a specialty drug?
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.
How can I use a specialty pharmacy?
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.
What is the approximate turnaround time for specialty drugs to be delivered once the order is complete?
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.
