Prescription Drug Program

The Prescription Drug Plan rules for eligibility and information on maintaining coverage is the same as those for the State Health Benefits Program (SHBP)
  • The prescription drug program is separate from your medical plan
  • The program is managed by Caremark on behalf of Horizon Blue Cross Blue Shield of New Jersey
  • Most pharmacies in New Jersey participate in the program
  • If you use a non-participating pharmacy, you must file a claim for reimbursement.  You can obtain prescription drug reimbursement forms from the Department of Human Resources or at:
  • Eligibility begins and ends on the same date as your health plan coverage
  • Benefits are available through a participating retail pharmacy, the plans designated mail order service, or from a participating specialty pharmaceutical provider
  • Normally, retail pharmacy co-payment amounts are for a 30-fay supply.  However, you may obtain up to a 90-day supply of your prescription drug.  To do so, you must pay two co-payments for a 31-60 day supply or three co-payments for a 61-90 day supply
  • Mail order benefits are available where participants can receive up to a 90 day supply of prescription drugs for one co-payment.
  • Specialty pharmaceuticals are oral or injected drugs that have unique production, administration, or distribution requirements.  They require specialized patient education prior to use and ongoing patient assistance while under treatment
  • Mail order forms are available in the Department of Human Resources.  You can obtain a mail order refill by mail, using a pre-addressed envelope, by phone at Member Services 866-881-5605 or on the Internet at:
  • $3.00 co-payment for up to a 30-day supply of generic drugs
  • $10.00 co-payment for up to a 30-day supply of brand name drugs
  • $5.00 co-payment for a 90-day supply of generic drugs through the Mail Order Service
  • $15.00 co-payment for a 90-day supply of brand name drugs through the Mail Order Service