Formulary (list of covered drugs) for Blue Shield of California Medicare Plans | Blue Shield Medicare
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Formulary (list of covered drugs) for Blue Shield of California Medicare Plans

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 list of covered drugs in our Medicare Advantage and Medicare Prescription Drug Plans (see Formulary by plan section below). 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 formularies contain medications that the Food and Drug Administration (FDA) has reviewed and approved. The Blue Shield Pharmacy and Therapeutics (P&T) Committee develops and updates the formulary regularly to ensure it meets 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. Committee voting members  are not  Blue Shield of California employees. To assist physicians in prescribing medically appropriate and cost-effective medications, the P&T Committee reviews: 

  • Medical literature
  • FDA drug labels 
  • 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 Select (PPO), Blue Shield Balance (HMO), and Blue Shield Enhanced (HMO) should 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 TotalDual Plan (HMO D-SNP in Los Angeles and San Diego counties) should 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 Select (PPO) or Blue Shield Medicare (PPO) plan, your Part B drugs may be subject to step therapy. View the Part B Step Therapy Criteria: English (PDF, 2.6 MB), Español (PDF, 138 KB).
 

Important message about your costs for vaccines and insulin:

  • What you pay for vaccines – Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible, if applicable. Call Customer Care for more information.
  • What you pay for insulin – You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible, if applicable.

 

Formulary by plan (PDF)

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

 (Coming soon)

  • Blue Shield TotalDual Plan (HMO D-SNP) – Los Angeles and San Diego counties, English (PDF, 1.5 MB)
  • Blue Shield TotalDual Plan (HMO D-SNP) – Los Angeles and San Diego counties, Spanish (PDF, 4 MB)
  • Blue Shield TotalDual Plan (HMO D-SNP) – Los Angeles and San Diego counties, Chinese
  • Blue Shield TotalDual Plan (HMO D-SNP) – Los Angeles and San Diego counties, Arabic
  • Blue Shield TotalDual Plan (HMO D-SNP) – Los Angeles and San Diego counties, Armenian
  • Blue Shield TotalDual Plan (HMO D-SNP) – Los Angeles and San Diego counties, Cambodian
  • Blue Shield TotalDual Plan (HMO D-SNP) – Los Angeles and San Diego counties, Farsi
  • Blue Shield TotalDual Plan (HMO D-SNP) – Los Angeles and San Diego counties, Korean
  • Blue Shield TotalDual Plan (HMO D-SNP) – Los Angeles and San Diego counties, Russian
  • Blue Shield TotalDual Plan (HMO D-SNP) – Los Angeles and San Diego counties, Tagalog
  • Blue Shield TotalDual Plan (HMO D-SNP) – Los Angeles and San Diego counties, Vietnamese

Formulary by plan

  • Medicare Advantage Prescription Drug Plan formularies (lists of covered drugs)

    Blue Shield 65 Plus (HMO) – Los Angeles, Orange, and San Bernardino counties

    Blue Shield 65 Plus (HMO) – Riverside County

    Blue Shield 65 Plus (HMO) – San Diego County

    Blue Shield 65 Plus (HMO) – San Luis Obispo and Santa Barbara counties

    Blue Shield 65 Plus (HMO) – Ventura and Kern counties

    Blue Shield 65 Plus Choice Plan (HMO) – San Bernardino and Riverside counties

    Blue Shield 65 Plus Plan 2 (HMO) – Los Angeles and Orange counties

    Blue Shield AdvantageOptimum Plan (HMO) – Los Angeles and Orange counties

    Blue Shield AdvantageOptimum Plan 1 (HMO) – San Diego County

    Blue Shield Balance (HMO) – Los Angeles County

    Blue Shield Enhanced (HMO) – Los Angeles and Orange counties

    Blue Shield Inspire (HMO D-SNP) – Fresno, San Joaquin, Stanislaus, and Merced counties

    Blue Shield Inspire (HMO) – Alameda, San Mateo, San Joaquin, Stanislaus, Merced, Fresno, Madera, and Santa Clara counties

    Blue Shield Inspire (HMO) – Sacramento, Los Angeles, and Orange counties

    Blue Shield Select (PPO) – Alameda County, Orange and San Diego counties

    Blue Shield TotalDual Plan (HMO D-SNP) – Orange and San Bernardino counties

  • List of formularies for PDP plans
  • Coverage through your former employer/union

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Page last updated: 7/31/2022

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