Medicare Part D

Click the links to learn about Medicare Part D prescription drug formularies.

 

Individual and Family Plan and Small Groups (1-100 employees) including Covered California*

Learn about different drug coverage topics for members in Individual and Family Plans (IFP) or small group plans. These prescription drug benefits can be obtained from Covered California or directly from Blue Shield of California. To find the formulary applicable to you, refer to your Evidence of Coverage or Certificate of Insurance to determine your plan name. The plan names are noted above each formulary in the list below.

Drug formulary: Refer to your plans drug formulary for a list of Blue Shield preferred generic and brand-name medications.

Specialty drug list: Refer to this specialty drug list for specialty drugs that are only available through a Blue Shield Network Specialty Pharmacy. Select drugs may not be available for distribution through the Network Specialty Pharmacy in which case it may be obtained through a non-network specialty pharmacy.

Preventive drug list: Refer to this preventive drug list to see drugs for which health reform requires coverage at $0 member share of cost.

Contraceptive drug list: Refer to this contraceptive drugs list to see drugs and devices covered at $0 member share of cost.

Vaccine drug list: For eligible non-grandfathered plans, refer to this vaccine list for vaccines covered at participating retail pharmacies and to locate pharmacies available for vaccine administration.

2019 Standard Drug Formulary for the following Department of Managed Health Care (DMHC) plans: Blue Shield Platinum 90 PPO, Blue Shield Gold 80 PPO, Blue Shield Silver 70 PPO, Blue Shield Silver 73 PPO, Blue Shield Silver 87 PPO, Blue Shield Silver 94 PPO, Blue Shield Bronze 60 PPO, Blue Shield Bronze 60 HDHP PPO, Blue Shield Minimum Coverage PPO, Blue Shield $0 Cost Share PPO, Silver 1850 PPO , Blue Shield Silver 73 Trio HMO, Blue Shield Silver 87 Trio HMO, Blue Shield Silver 94 Trio HMO, Shield Spectrum PPO℠ Plan 2000, Blue Shield $0 Cost Share Trio HMO, Silver 70 Off Exchange PPO, Silver 70 Off Exchange Trio HMO, Blue Shield Trio Platinum 90 HMO, Blue Shield Trio Gold 80 HMO, Blue Shield Trio Silver 70 HMO, Bronze Full PPO, Bronze Full PPO Savings, Bronze Tandem PPO, Gold Access+ HMO, Gold Full PPO, Gold Local Access+ HMO, Gold Tandem PPO, Gold Trio HMO, Platinum Access + HMO, Platinum Full PPO, Platinum Local Access+ HMO, Platinum Tandem PPO, Platinum Trio HMO, Silver Access+ HMO, Silver Full PPO, Silver Full PPO Savings, Silver Local Access+ HMO, Silver Tandem PPO, Silver Tandem PPO Savings, Silver Trio HMO

2020 Standard Drug Formulary for Department of Managed Health Care (DMHC) plans:

For members who are in IFP Grandfathered Plan, select the formulary that applies to your plan name.  For all other IFP and Small Business plans, select the formulary above.

2019 Plus Drug Formulary for the following California Department of Insurance (CDI) grandfathered plans: Active Start℠ Plan 35-G, Balance Plan 1000-G, Balance Plan 1700-G, Balance Plan 2500-G, Shield Savings℠ 5200-G, Shield Savings℠ 1800/3600-G, Shield Savings℠ 3500-G, Shield Savings℠ 4000/8000-G, Shield Spectrum PPO℠ Plan 5000-G (w/CCP), Vital Shield 2900-G, Vital Shield 900-G, Vital Shield Plus 900 Generic Rx-G, Shield Spectrum PPOSM Plan 5000-G (No CCP)

2020 Plus Drug Formulary for the following California Department of Insurance (CDI) grandfathered plans:

2019 Plus Drug Formulary for the following Department of Managed Health Care (DMHC) grandfathered plans: Shield Savings℠ 2400/4800-G and Shield Spectrum PPO℠ Plan 2000-G

2020 Plus Drug Formulary for the following Department of Managed Health Care (DMHC) grandfathered plans:

Large Groups (101+ employees)

Learn about different drug coverage topics for members in large group plans.

To find the formulary applicable to you, refer to your Evidence of Coverage or Certificate of Insurance to determine your plan name. The plan names are noted above each formulary in the list below.

Drug formulary: Refer to your plans drug formulary for a list of Blue Shield preferred generic and brand-name medications.

Specialty drug list: Refer to this specialty drug list for specialty drugs that are only available through a Blue Shield Network Specialty Pharmacy. Select drugs may not be available for distribution through the Network Specialty Pharmacy in which case it may be obtained through a non-network specialty pharmacy.

Preventive drug list: Refer to this preventive drug list to see drugs for which health reform requires coverage at $0 member share of cost.

Contraceptive drug list: Refer to this contraceptive drugs list to see drugs and devices covered at $0 member share of cost.

Vaccine drug list: For eligible non-grandfathered plans, refer to this vaccine list for vaccines covered at participating retail pharmacies and to locate pharmacies available for vaccine administration.

Value-Based Tier Drug List: For select Blue Shield plans with the Value-Based Tier Drug (VBTD) benefit, refer to this list for drugs that are covered at no charge, or at an otherwise reduced cost-share. Refer to your Evidence of Coverage or Certificate of Insurance to determine if you have this benefit.

Maintenance drug list (PDF, 227KB):  For members with a mandatory mail service or maintenance drug benefit, refer to this maintenance list for drugs that you should fill at the mail service pharmacy. Blue Shield's mail service pharmacy may also fill other maintenance drugs not listed.

2019 Plus Drug Formulary for the following Department of Managed Health Care (DMHC) plans: Shield Spectrum PPO℠, Full PPO, Full PPO Savings, Access+ HMO®, Added Advantage POS℠, Local Access+ HMO®, Tandem PPO, Trio HMO


2020 Plus Drug Formulary for the following Department of Managed Health Care (DMHC) plans:

2019 Plus Drug Formulary for the following California Department of Insurance (CDI) plans: Active Choice® 500 80/50, Active Choice® 500 80/50 1500 Deductible, Active Choice® 750 70/50, Active Choice® 750 70/50 1000 Deductible, Active Choice® 750 80/60

2020 Plus Drug Formulary for the following California Department of Insurance (CDI) plans:

2019 Value Drug Formulary for the following Department of Managed Health Care (DMHC) plans: Shield Spectrum PPO℠, Full PPO, Full PPO Savings, Access+ HMO®, Added Advantage POS℠, Local Access+ HMO®, Tandem PPO, Trio HMO

2020 Value Drug Formulary for the following Department of Managed Health Care (DMHC) plans: