January 2021 Prescription Drug Options

Large Groups (101 and above)

You can offer your clients prescription drug options with a range of copayments and rates. These options – more than 85 in all – cover drugs and supplies in the Blue Shield Drug Formulary, including drugs and devices, contraceptives, diabetic supplies and more. You'll have flexibility when offering affordable choices that enhance your clients' medical plan.

Select a drug coverage plan to accompany the health plan your client is interested in. The information below is effective January 1, 2021 for groups with 101 or more eligible employees.

Broker Resources

2020 Prescription Drug Options | 2019 Prescription Drug Options | 2018 Prescription Drug Options | Forms and Applications

Benefit Modification Brochures | Group administrator guide | Employer Connection provides resources for your clients | Network

Prescription Drug Options

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Basic Rx Riders for HMO and POS Plans	Download	Size
Basic Rx $10/15 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $10/15 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $10/20 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $10/20 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $10/20 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $10/25 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $10/25 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $15/25 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $15/25 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $15/25 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $15/30 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $15/30 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Basic Rx $15/30 with $250 Pharmacy Deductible	English Spanish	998KB 115KB

Enhanced Rx Riders for HMO and POS Plans	Download	Size
Enhanced Rx $5/10/25 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $5/10/25 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $10/15/30 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $10/15/30 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $10/20/35 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $10/20/35 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $10/25/40 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $10/25/40 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $10/25/40 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $10/30/50 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $10/30/50 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $10/30/50 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $15/30/45 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $15/30/45 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $15/30/45 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $15/30/50% $100 max with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $15/30/50% $100 max with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $15/30/50% $100 max with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $15/30/50% $100 max with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $15/40/70 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $15/40/70 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $15/40/70 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $20/40/60 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $20/40/60 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx $20/40/60 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $10/20/35 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $10/25/35 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $10/25/40 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $10/25/40 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $10/25/40 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $10/30/50 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $10/30/50 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $10/30/50 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $15/30/45 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $15/30/45 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $15/30/45 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $15/40/70 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $15/40/70 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $15/40/70 with $250 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $20/40/60 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $20/40/60 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Enhanced Rx - Value Formulary $20/40/60 with $250 Pharmacy Deductible	English Spanish	998KB 115KB

Premier Rx Riders for HMO and POS Plans	Download	Size
Premier Rx $0/10/25/40 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Premier Rx $0/10/25/40 with $150 Pharmacy Deductible	English Spanish	998KB 115KB
Premier Rx $0/10/25/40 with $250 Pharmacy Deductible	English Spanish	998KB 115KB

RX Spectrums Riders for HMO and POS Plans	Download	Size
Rx Spectrum $10/25/40 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Rx Spectrum $15/30/45 with $0 Pharmacy Deductible	English Spanish	998KB 115KB
Rx Spectrum $15/30/45 with $150 Pharmacy Deductible	English Spanish	998KB 115KB

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Enhanced Rx Riders for PPO/EPO Plans	Download	Size
Enhanced Rx $5/10/25 with $0 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $5/10/25 with $150 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $10/15/30 with $0 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $10/15/30 with $150 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $10/15/30 with $250 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $10/20/35 with $0 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $10/20/35 with $150 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $10/20/35 with $250 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $10/25/40 with $0 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $10/25/40 with $150 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $10/25/40 with $250 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $10/30/50 with $0 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $10/30/50 with $150 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $10/30/50 with $250 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $15/30/45 with $0 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $15/30/45 with $150 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $15/30/45 with $250 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $15/30/50% $100 max with $0 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $15/30/50% $100 max with $150 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $15/30/50% $100 max with $250 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $15/40/70 with $0 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $15/40/70 with $150 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $15/40/70 with $250 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $20/40/60 with $0 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $20/40/60 with $150 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx $20/40/60 with $250 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx - Value Formulary $10/20/35 with $0 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx - Value Formulary $10/20/35 with $150 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx - Value Formulary $10/20/35 with $250 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx - Value Formulary $10/25/40 with $0 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx - Value Formulary $10/25/40 with $150 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx - Value Formulary $10/25/40 with $250 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx - Value Formulary $10/30/50 with $0 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx - Value Formulary $10/30/50 with $150 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx - Value Formulary $10/30/50 with $250 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx - Value Formulary $15/30/45 with $0 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx - Value Formulary $15/30/45 with $150 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx - Value Formulary $15/30/45 with $250 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx - Value Formulary $15/40/70 with $0 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx - Value Formulary $15/40/70 with $150 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx - Value Formulary $15/40/70 with $250 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx - Value Formulary $20/40/60 with $0 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx - Value Formulary $20/40/60 with $150 Pharmacy Deductible	English Spanish	1MB 120KB
Enhanced Rx - Value Formulary $20/40/60 with $250 Pharmacy Deductible	English Spanish	1MB 120KB

Premier Rx Riders for PPO/EPO Plans	Download	Size
Premier Rx $0/10/25/40 with $0 Pharmacy Deductible	English Spanish	1MB 120KB
Premier Rx $0/10/25/40 with $150 Pharmacy Deductible	English Spanish	1MB 120KB

Rx Spectrum Riders for PPO Plans	Download	Size
Rx Spectrum $0/10/25/40 with $0 Pharmacy Deductible	English Spanish	1MB 120KB
Rx Spectrum $10/25/40 with $0 Pharmacy Deductible	English Spanish	1MB 120KB
Rx Spectrum $15/30/45 with $0 Pharmacy Deductible	English Spanish	1MB 120KB
Rx Spectrum $15/30/45 with $150 Pharmacy Deductible	English Spanish	1MB 120KB
Rx Spectrum $15/30/50% $100 max with $250 Pharmacy Deductible	English Spanish	1MB 120KB

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Enhanced Rx Riders for Active Choice Plans	Download	Size
Enhanced Rx $10/25/40 with $0 Pharmacy Deductible	English Spanish	740KB 770KB
Enhanced Rx $10/25/40 with $150 Pharmacy Deductible	English Spanish	740KB 770KB
Enhanced Rx $10/25/40 with $250 Pharmacy Deductible	English Spanish	740KB 770KB
Enhanced Rx $15/30/45 with $0 Pharmacy Deductible	English Spanish	740KB 770KB
Enhanced Rx $15/30/45 with $150 Pharmacy Deductible	English Spanish	740KB 770KB
Enhanced Rx $15/30/45 with $250 Pharmacy Deductible	English Spanish	740KB 770KB