Formularies for Blue Shield of California Medicare plans | Blue Shield Medicare

Formulary for prescriptions

Each Blue Shield of California Medicare Prescription Drug Plan has a list of drugs it covers. This list is called a formulary. You can access the lists covered in our Medicare Advantage and Medicare Prescription Drug Plans. If you have questions about how to better understand your formulary, visit our frequently asked questions

How our Medicare formularies work: 
Each of the Blue Shield of California formulary contains medications that have been reviewed and approved by the Food and Drug Administration (FDA). The 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 P&T Committee includes physicians and clinical pharmacists from our provider and pharmacy networks. Voting members of the committee 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 
  • National treatment guidelines to update the formulary and drug prior authorization criteria. 

All recommended changes to Blue Shield of California 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 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 for more information.

Medicare Part B diabetic test strips

Blue Shield 65 Plus (HMO), Blue Shield 65 Plus Plan 2 (HMO), Blue Shield Inspire (HMO), Blue Shield 65 Plus Choice Plan (HMO), Blue Shield Vital (HMO) refer to the following for more information:

  • Learn about Part B preferred diabetic test strips 

Blue Shield AdvantageOptimum Plan (HMO), Blue Shield TotalDual Plan (HMO D-SNP), Blue Shield Inspire (HMO D-SNP), and Blue Shield Coordinated Choice Plan (HMO) refer to the following for more information: 

  • Learn about Part B preferred diabetic test strips 

About Part B Step Therapy

If you are enrolled in a Blue Shield Inspire PPO plan, your Part B drugs may be subject to step therapy. View the Part B Step Therapy Criteria English (PDF, 83 KB), Español (PDF, 77 KB).

 

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

Formulary by plan

Y0118_20_663A_M Accepted 09292020

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

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