Medicare Prescription Drug Plans (PDP)
Blue Shield of California contracts with the Centers for Medicare & Medicaid Services (CMS) to offer two prescription drug plans to serve Medicare beneficiaries in the entire state of California.
Whether your clients are looking for drug coverage to complement their Medicare Supplement plan or a standalone Medicare prescription drug plan, you can offer a Blue Shield plan that fits their needs.
| Effective January 1, 2026 | Blue Shield Rx Plus (PDP) | Blue Shield Rx Enhanced (PDP) |
|---|---|---|
| Premium1 | $210.00 |
$238.00 |
Deductible (if applicable) doesn’t apply to covered insulin products and most adult Part D Vaccines IRA Insulins (Part D covered insulin) Members 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 member hasn't paid their deductible |
$615 | $0 |
Medicare Part D Vaccine Our plan covers most Part D vaccines at no cost to you even if you haven’t paid your deductible (if applicable). Call Customer Service for more information. |
$0 | $0 |
| Copays and coinsurance amounts are for a 30-day supply at network pharmacies* that offer preferred cost-sharing. | ||
| Tier 1 Preferred Generic Drugs | $0 copayment | $0 copayment |
| Tier 2 Generic Drugs | $7 copayment | $7 copayment |
| Tier 3 Preferred Brand Drugs | 19% coinsurance | 19% coinsurance |
| Tier 3 Covered Insulins | The lesser of $35 copayment or 19% coinsurance | The lesser of $35 copayment or 19% coinsurance |
| Tier 4 Non-Preferred Drugs | 49% coinsurance | 37% coinsurance |
| Tier 4 Covered Insulins | The lesser of $35 copayment or 25% coinsurance | The lesser of $35 copayment or 25% coinsurance |
| Tier 5 Specialty Tier Drugs | 25% coinsurance | 33% coinsurance |
*Pharmacies with preferred cost-sharing2 Amazon Pharmacy,3 Albertsons/Osco/Savon, Costco, CVS Pharmacy® (including CVS Pharmacy at Target), Safeway, and Vons
Who is eligible?
- California residents who have Medicare Part A or Medicare Part B (or have both Medicare Part A and Part B)
Selling our PDP plans
You can market and sell our PDP plans during the Medicare Annual Enrollment Period from October 15 to December 7.
Earn market-competitive commissions on every sale. This includes sales outside of the Medicare Annual Enrollment, to individuals who are new to Medicare and eligible for a Special Enrollment Period. Remember, you must be certified each year through AHIP and pass Blue Shield’s product-specific training. Also, you must be individually appointed with Blue Shield or endorsed through an agency that is appointed with Blue Shield to earn commissions. Get started today.
1 Members must continue to pay their Medicare Part B premium.
2 The Formulary and/or Pharmacy network may change at any time. Members will receive notice when necessary.
3 Amazon Pharmacy is independent of Blue Shield of California and is contracted by Blue Shield to provide home delivery of prescription medications to Blue Shield members. Members are responsible for their share of costs, as stated in their benefit plan details. Information about specific prescription drug benefits and drug benefit exclusions can be found in the member's plan documents. Members may call the Customer Service number on their Blue Shield member ID card if they have questions about their Blue Shield prescription drug coverage.
Blue Shield of California’s pharmacy network includes limited lower-cost, pharmacies with preferred cost sharing in certain counties within California. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost pharmacies with preferred cost sharing in your area, please call Customer Service at (888) 239-6469 (TTY: 711), 8 a.m. to 8 p.m. PT, seven days a week, or consult the online pharmacy directory at blueshieldca.com/medpharmacy2025. Blue Shield of California’s pharmacy network includes limited lower-cost, preferred pharmacies in certain counties within California. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call (888) 239-6469 (TTY: 711), 8 a.m. to 8 p.m. PT, seven days a week or consult the online pharmacy directory.
The company complies with applicable state laws and federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, ethnic group identification, medical condition, genetic information, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, mental disability, or physical disability. La compañía cumple con las leyes de derechos civiles federales y estatales aplicables, y no discrimina, ni excluye ni trata de manera diferente a las personas por su raza, color, país de origen, identificación con determinado grupo étnico, condición médica, información genética, ascendencia, religión, sexo, estado civil, género, identidad de género, orientación sexual, edad, ni discapacidad física ni mental. 本公司遵守適用的州法律和聯邦民權法律，並且不會以種族、膚色、原國籍、族群認同、醫療狀況、遺傳資訊、血統、宗教、性別、婚姻狀況、性別認同、性取向、年齡、精神殘疾或身體殘疾而進行歧視、排斥或區別對待他人。
Page last updated 10/1/2025
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