Formulary - drugs in the plan

Each Medicare prescription drug plan has a list of drugs it covers. This list is called a formulary. Access these drugs lists covered in our Medicare Advantage, and Medicare Prescription Drug Plans.

The Blue Shield of California formulary is developed and updated regularly by the Blue Shield Pharmacy and Therapeutics (P&T) Committee and meets all Medicare requirements for included and excluded drugs. The Blue Shield of California Formulary contains medications that have been reviewed and approved by the Food and Drug Administration (FDA).

The Blue Shield P&T Committee includes physicians and clinical pharmacists from our provider and pharmacy networks, and voting members are not employees of Blue Shield of California. To assist physicians in prescribing medically appropriate and cost-effective medications, the P&T Committee reviews medical literature, the FDA drug label, and national treatment guidelines to update the formulary and drug prior authorization criteria. All recommended changes to Blue Shield Medicare formularies and drug prior authorization criteria are first approved by the Centers for Medicare and Medicaid Services (CMS), which provides oversight of the Medicare program.

If your selected plan does not cover a specific drug, you can ask Blue Shield of California to make an exception to the rules that govern coverage. Visit Coverage determinations and exceptions page for more information

Formulary by plan

Select a plan below to see a list of drugs covered under that plan. Formularies are available online and in PDF format for download: you will need Adobe Reader to view the PDF. 

Medicare Part B Diabetic Test Strips for Medicare Advantage - Prescription Drug Plans

Learn about Part B preferred diabetic test strips (PDF, 106KB).

Medicare Part B Diabetic Test Strips for Medicare Advantage - Prescription Drug Plans Group Plan Formulary

Learn about Part B preferred diabetic test strips (PDF, 106KB)

If you are enrolled in Blue Shield Medicare (PPO) plan, your Part B drugs may be subject to Step Therapy. View the Part B Step Therapy Criteria.(PDF, 54KB)

Out-of-network coverage

Learn when Blue Shield may pay for a prescription filled at a pharmacy outside of our network.

Learn about non-network coverage

Prior authorization forms and guidelines

Access fax forms to request a coverage determination.

Find prior authorization request forms

Over-the-counter benefit

Some of our plans come with an over-the-counter (OTC) benefit which covers OTC health and wellness products including first-aid supplies, pain relievers, cough/cold and allergy medicines, and more.

Learn more about this benefit

Transition policy

Learn about our transition process for members stabilized on Part D drugs that are not included in their plan's formulary or drugs that have specific requirements or limits.

Learn more about our policy

Frequently asked questions

Get answers to frequently asked questions about our Medicare Advantage (HMO and PPO) and Medicare Prescription Drug Plans.

Read FAQs

Medication therapy management program

Blue Shield has a program that helps members with certain chronic conditions better manage their drug therapy.

Learn more about the program

Coverage determinations and exceptions

Learn about exceptions if you find our plan does not cover your medication and how you can ask us to make an exception to our coverage rules.

Learn more about coverage determinations

Medicare Part D formulary user guide

Use our Medicare Part D guide to understand drug coverage requirements, authorization, and step therapy requirements.

View user guide

Centro de Recursos en Español

Conozca detalladamente sobre el planes HMO y PPO de Medicare Advantage, planes de Medicamentos recetados de Medicare (PDP), y sobre formularios de inscripción en español.

Conozca sus opciones

Y0118_19_582B_C Accepted 09272019 

Page last updated: 09/30/2019

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Medicare has neither reviewed nor endorsed this information. Blue Shield of California is an HMO, PPO, and PDP plan with a Medicare contract. Enrollment in Blue Shield of California depends on contract renewal.

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