Each Blue Shield of California Medicare Advantage and 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 the Coverage determinations and exceptions page 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:
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:
About Part B Step Therapy
Formulary by plan
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.