Drug formularies

Medicare Part D Individual and Employer Group Plans

Click the links to learn about Medicare Part D prescription drug formularies.

Medicare Part D Individual and Employer Group Plan prescription drug formularies
 

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

Learn about different drug coverage topics for members in Individual and Family Plans (IFP) or small group plans. You can obtain these prescription drug benefits from Covered California or directly from Blue Shield of California. To find the formulary applicable to you, refer to your Evidence of Coverage or Certificate of Insurance to determine your plan name. The plan names are noted above each formulary in the list below.

Drug formulary: Refer to your plan’s drug formulary for a list of Blue Shield preferred generic and brand-name medications.

Specialty drug list: Refer to this specialty drug list for specialty drugs that are only available through a Blue Shield Network Specialty Pharmacy. Select drugs may not be available for distribution through the Network Specialty Pharmacy, in which case you may obtain them through a non-network specialty pharmacy.

Preventive drug list (ACA): Refer to this preventive drug list to see drugs for which Health Care Reform (Affordable Care Act or ACA) requires coverage at $0 member share of cost.

Contraceptive drug list: Refer to this contraceptive drugs list to see drugs and devices covered at $0 member share of cost.

HDHP Preventive drug list: HDHP preventive drugs are specific preventive drugs that may be covered pre-deductible in high-deductible healthcare plans (HDHPs). Refer to your Evidence of Coverage or Certificate of Insurance to determine if you have this benefit.

Vaccine drug list: For eligible non-grandfathered plans, refer to this vaccine list for vaccines covered at participating retail pharmacies and to locate pharmacies available for vaccine administration.

Standard Drug Formulary for the following Department of Managed Health Care (DMHC) plans: Blue Shield Platinum 90 PPO, Blue Shield Gold 80 PPO, Blue Shield Silver 70 PPO, Blue Shield Silver 73 PPO, Blue Shield Silver 87 PPO, Blue Shield Silver 94 PPO, Blue Shield Bronze 60 PPO, Blue Shield Bronze 60 HDHP PPO, Blue Shield Minimum Coverage PPO, Blue Shield $0 Cost Share PPO, Silver 1750 PPO , Blue Shield Silver 73 Trio HMO, Blue Shield Silver 87 Trio HMO, Blue Shield Silver 94 Trio HMO, Blue Shield $0 Cost Share Trio HMO, Silver 70 Off Exchange PPO, Silver 70 Off Exchange Trio HMO, Blue Shield Trio Platinum 90 HMO, Blue Shield Trio Gold 80 HMO, Blue Shield Trio Silver 70 HMO, Bronze 7500 Trio HMO, Silver 2600 HDHP PPO, Bronze Full PPO, Bronze Full PPO Savings, Bronze Tandem PPO, Gold Access+ HMO, Gold Full PPO, Gold Local Access+ HMO, Gold Tandem PPO, Gold Trio HMO, Platinum Access + HMO, Platinum Full PPO, Platinum Local Access+ HMO, Platinum Tandem PPO, Platinum Trio HMO, Silver Access+ HMO, Silver Full PPO, Silver Full PPO Savings, Silver Local Access+ HMO, Silver Tandem PPO, Silver Tandem PPO Savings, Silver Trio HMO, Bronze Trio HMO, Bronze Access+ HMO, Bronze Local Access+ HMO, Bronze Tandem PPO Savings, Gold Full PPO Savings, Gold Tandem PPO Savings, Virtual Blue Bronze and Gold Tandem PPO

 

For members who are in IFP Grandfathered Plan, select the formulary that applies to your plan name. For all other IFP and Small Business plans, select the formulary above.

Plus Drug Formulary for the following California Department of Insurance (CDI) grandfathered plans: Active Start℠ Plan 35-G, Balance Plan 1000-G, Balance Plan 1700-G, Balance Plan 2500-G, Shield Savings℠ 5200-G, Shield Savings℠ 1800/3600-G, Shield Savings℠ 3500-G,  Shield Spectrum PPO℠ Plan 5000-G, Vital Shield 2900-G, Vital Shield 900-G, Vital Shield Plus 900 Generic Rx-G

 

Large Groups (101+ employees)

Learn about different drug coverage topics for members in large group plans.

To find the formulary applicable to you, refer to your Evidence of Coverage or Certificate of Insurance to determine your plan name. The plan names are noted above each formulary in the list below.

Drug formulary: Refer to your plan’s drug formulary for a list of Blue Shield preferred generic and brand-name medications.

Specialty drug list: Refer to this specialty drug list for specialty drugs that are only available through a Blue Shield Network Specialty Pharmacy. Select drugs may not be available for distribution through the Network Specialty Pharmacy, in which case you may  obtain them through a non-network specialty pharmacy.

Preventive drug list (ACA): Refer to this preventive drug list to see drugs for which Health Care Reform (Affordable Care Act or ACA) requires coverage at $0 member share of cost.

Contraceptive drug list: Refer to this contraceptive drugs list to see drugs and devices covered at $0 member share of cost.

HDHP (high-deductible health plans) Preventive drug list: HDHP preventive drugs are specific preventive drugs that may be covered pre-deductible in  HDHPs. Refer to your Evidence of Coverage or Certificate of Insurance to determine if you have this benefit.

Vaccine drug list: For eligible non-grandfathered plans, refer to this vaccine list for vaccines covered at participating retail pharmacies and to locate pharmacies available for vaccine administration.

Value-Based Tier drug List: For select Blue Shield plans with the Value-Based Tier Drug (VBTD) benefit, refer to this 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 this benefit.

Plus Drug Formulary for the following Department of Managed Health Care (DMHC) plans: Shield Spectrum PPO℠, Full PPO, Full PPO Savings, Access+ HMO®, Added Advantage POS℠, Local Access+ HMO®, Tandem PPO, Trio HMO, Active Choice Plus®, Active Choice Classic®

 

Plus Drug Formulary for the following California Department of Insurance (CDI) plans: Active Choice® 500 80/50, Active Choice® 500 80/50 1500 Deductible, Active Choice® 750 70/50, Active Choice® 750 70/50 1000 Deductible, Active Choice® 750 80/60

 

Plus Drug Formulary for Department of Managed Health Care (DMHC) grandfathered plans: Shield Savings℠ 2400/4800-G, Shield Spectrum PPO℠ Plan 2000-G

 

Value Drug Formulary for the following Department of Managed Health Care (DMHC) plans: Shield Spectrum PPO℠, Full PPO, Full PPO Savings, Access+ HMO®, Added Advantage POS℠, Local Access+ HMO®, Tandem PPO, Trio HMO

 

Prime Formulary for the following plans: ASO PPO, PPO Preferred Savings, ASO EPO

Formulary changes

Our prescription drug formularies are updated monthly. Formulary change announcements are updated quarterly.

Read recent changes

Formulary FAQs

Get answers to your prescription drug questions.

Learn more

Y0118_22_513A_C 09152022

Page last updated: 11/24/2022

© Blue Shield of California 1999-2022. All rights reserved. Blue Shield of California is an independent member of the Blue Shield Association.

This information is not a complete description of benefits.

The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

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。
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© California Physicians’ Service DBA Blue Shield of California 1999-2023. 保留所有权利。 California Physicians’ Service DBA Blue Shield of California is an independent member of the Blue Shield Association. 健康保险产品是由 Blue Shield of California Life & Health Insurance Company 提供的。健康计划是由 Blue Shield of California 提供的。

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