What is the Blue Shield of California Promise Health Plan Comprehensive Formulary?
A formulary is a list of health plan covered drugs. The Blue Shield of California Promise Health Plan Formulary lists drugs that are considered a necessary part of a quality treatment program. Our formulary is available to all Plan members.
Blue Shield of California Promise Health Plan will generally cover the drugs listed in our formulary as long as:
- The drug is medically necessary
- The prescription is filled at a Blue Shield of California Promise Health Plan network pharmacy
- Other plan rules are followed
For more information on how to fill your prescriptions, please review your Evidence of Coverage (EOC)
Blue Shield of California Promise Health 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.
The Medicare program allows us to make changes in our prescription drug formulary list any time during the calendar year. A change in our drug formulary could affect which drugs are covered, the member's copayment, and the limit on usage.
2020 Blue Shield Promise Medicare Plan Formulary
Our list of drugs is updated monthly. For the most current list, search our online drug formulary or call Member Services.
Download 2020 Blue Shield Promise Medicare Plan Formulary, last updated on 7/28/2020. It is the HPMS Approved Formulary ID 20417, Version 28:
Formulary, English (PDF, 3.7 MB)
Formulary, Spanish (PDF, 1.6 MB)
What are your drug costs?
You may need to pay copayment/coinsurance for some prescription drugs on our list of covered drugs. Copayment/coinsurance vary based on the plan and your area of residence. You can read the Blue Shield of California Promise Health Plan 2020 Formulary to learn about the copay for each drug.
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.