What is the Blue Shield of California Promise Cal MediConnect Plan formulary?

A formulary is a list of covered drugs selected by Blue Shield of California Promise Health Plan in consultation with a team of health care providers. The list of drugs represents the prescription therapies believed to be a necessary part of a quality treatment program. Blue Shield of California Promise Cal MediConnect Plan comprehensive formulary lists drugs that members can get.

Blue Shield Promise Cal MediConnect Plan covers both brand-name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand-name drug. Generic drugs usually cost less than brand-name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand-name drugs. Your co-payment amount will vary from $0 to $9.20 per drug depending on your income.

Blue Shield Promise Cal MediConnect Plan also covers certain Non-Part D / over-the-counter (OTC) drugs that are covered. You will pay $0 co-pay for all Non-Part D / OTC drugs that are covered. Please refer to the Blue Shield Promise Cal MediConnect Plan Drug Formulary below for the covered Non-Part D / OTC drugs (see Tier 4 drugs).

2021 Blue Shield Promise Cal MediConnect Plan formulary

Our list of drugs is updated monthly. For the most current list, search our online drug formulary or call Customer Care.

Search 2021 Blue Shield Promise Cal MediConnect Plan formulary online

Blue Shield Promise Cal MediConnect Plan drug formulary printed document (in PDF format)

Printed document (in PDF format) listed in this section are Approved HPMS Formulary ID: 20418, Version: 24, last updated on 9/22/2020, and are available for download below:

2021 Cal MediConnect List of Covered Drugs, English (PDF, 2.1 MB)
2021 Cal MediConnect List of Covered Drugs, Spanish (PDF, 2.2 MB)
2021 Cal MediConnect List of Covered Drugs, Chinese (PDF, 2.4 MB)
2021 Cal MediConnect List of Covered Drugs, Arabic (PDF, 2.1 MB)
2021 Cal MediConnect List of Covered Drugs, Armenian (PDF, 2.2 MB)
2021 Cal MediConnect List of Covered Drugs, Cambodian (PDF, 2.2 MB)
2021 Cal MediConnect List of Covered Drugs, Farsi (PDF, 2.2 MB)
2021 Cal MediConnect List of Covered Drugs, Korean (PDF, 2.5 MB)
2021 Cal MediConnect List of Covered Drugs, Russian (PDF, 2.3 MB)
2021 Cal MediConnect List of Covered Drugs, Tagalog (PDF, 2.1 MB)
2021 Cal MediConnect List of Covered Drugs, Vietnamese (PDF, 2.2 MB)

Request a printed copy of the drug formulary

Drug coverage exception

An exception is a request to get coverage for a drug that is not normally on our List of Covered Drugs (formulary), or to use the drug without certain rules and limitations. If a drug is not on our list of covered drugs or is not covered in the way you would like, you can ask us to make an "exception." When you ask for an exception, your doctor or other prescriber needs to explain the medical reasons why you need it.

For more information please review your Member Handbook document, Chapter 9 Section 6.2.

Read the instructions on submitting a drug coverage exception request.

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