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Blue Shield members:
Log in to view your plan-specific drug copayments.

Formulary Changes

Updated March 2016

We review and update our prescription drug formularies quarterly. Read about recent changes.

Drug Formularies

Select one of these plans to find more information about drug coverage under your benefits. Refer to the Drug Formulary for a list of Blue Shield preferred generic and brand-name medications. The formulary is a guide that helps our members choose cost-effective drug therapy. Additional drug lists are also available.


Medicare Part D

Click the link to learn about Medicare Part D prescription drug benefits and which drugs are covered in our plans.

Individual and Family Plan and Small Groups (1-100 Employees) including Covered California*

Click the links to learn about different drug coverage topics on the Standard Drug Formulary for members in Individual and Family Plans (IFP) or small group plans that have renewed their benefit. These prescription drug benefits can be obtained from Covered California or directly from Blue Shield of California.

2016 Standard Drug Formulary

*For members in grandfathered IFPs, refer to the Plus Drug Formulary (PDF, 2.76MB). Refer to this Specialty Drug list for specialty drugs that are obtainable only through a Blue Shield Network Specialty Pharmacy.  Refer to this Preventive Drug list to see drugs for which Health Reform requires coverage at $0 member share of cost. Refer to this Contraceptive Drugs list to see drugs and devices covered at $0 member share of cost. For non-grandfathered PPO and EPO plans, refer to this Vaccines list for covered vaccines, and for pharmacies available for vaccine administration.
 

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Large Groups (100+ Employees)*

Learn about different drug coverage topics on the Plus Drug Formulary for members in large group plans.

*For members in the 51-100 Small Business Transition plans or Simplified Plans, refer to the Standard Drug Formulary (PDF, 2.47MB).  Refer to this Specialty Drug list to view drugs that are obtainable only through a Blue Shield Network Specialty Pharmacy. For members with a mandatory mail service or maintenance drug benefit, refer to this Maintenance list for drugs you may fill at the mail service pharmacy. Blue Shield's mail service pharmacy may provide other maintenance drugs.   Refer to this Preventive Health list to see drugs that Health Reform requires to be covered at $0 member share of cost. Refer to this Contraceptive Drugs list to view drugs and devices covered at $0 member share of cost. For select Blue Shield plans with the Value-Based Tier Drug benefit (VBTD), refer to this VBTD list for drugs that are covered at no charge, or at an otherwise reduced cost-share. Refer to your Evidence of Coverage or Certificate of Insurance to determine if you have a Value-Based Tier Drug benefit. For non-grandfathered PPO and EPO plans, refer to this Vaccine list for covered vaccines and to locate pharmacies available for vaccine administration.

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If you are a Blue Shield member, you should check your Evidence of Coverage booklet/Certificate of Insurance/Policy to find out about drug coverage and how our formulary may apply to your specific plan.

Our formulary is updated quarterly by a group of community physicians and pharmacists and is subject to change. Please check back regularly for recent additions and deletions.