Medicare Part D Individual and Employer Group Plans

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

2024 Medicare Part D Individual and Employer Group Plan prescription drug formularies
2025 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: High-deductible health plan (HDHP) preventive drugs are specific preventive drugs that may be covered pre-deductible in high-deductible healthcare plans. 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: 

IFP: $0 Cost Share, Bronze 60 HDHP PPO, Bronze 60 PPO, Bronze 7500 Trio HMO, Gold 80, Minimum Coverage PPO, Platinum 90, Silver 1750 PPO, Silver 2600 HDHP PPO, Silver 70 Off Exchange, Silver 70, Silver 73, Silver 87, Silver 94

Small Group: Bronze Access+ HMO, Bronze Full PPO, Bronze Full PPO Savings, Bronze Local Access+, Bronze Tandem PPO, Bronze Tandem PPO Savings, Bronze 60, Bronze Trio HMO 7000/70 OffEx, Gold Access+ HMO, Gold Full PPO, Gold Full PPO Savings, Gold Local Access+ HMO, Gold Tandem PPO, Gold Tandem PPO Savings, Gold Trio HMO, Gold 80, Platinum Access+ HMO, Platinum Full PPO, Platinum Local Access+ HMO, Platinum Tandem PPO, Platinum Trio HMO, Platinum 90, Silver Access+ HMO, Silver Full PPO, Silver Full PPO Savings, Silver Local Access+ HMO, Silver Tandem PPO, Silver Tandem PPO Savings, Silver Trio HMO, Silver 70, Virtual Blue 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 2500-G, Shield Savings℠ 5200-G, Shield Savings℠ 1800/3600-G, Shield Spectrum PPO℠ Plan 5000-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 Preventive drug list: High-deductible health plans (HDHP) preventive drugs are specific preventive drugs that may be covered pre-deductible in high-deductible health plans. 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 EPO/PPO, Full PPO Savings, Access+ HMO®, Added Advantage POS℠, Local Access+ HMO®, Tandem EPO/PPO, Trio HMO, Active Choice Plus®, Active Choice Classic®, Virtual Blue EPO/PPO

 

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 EPO/PPO, Full PPO Savings, Access+ HMO®, Added Advantage POS℠, Local Access+ HMO®, Tandem EPO/PPO, Trio HMO, Virtual Blue PPO Savings

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_24_623A_C 09202024
H2819_24_623A_C Accepted 09302024

Page last updated: 10/01/2024

© Blue Shield of California 1999-2023. 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.

 1 Specialty medications and opioids are limited to a 30-day supply.

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

 © California Physician’s Service DBA Blue Shield of California 1999-2024. All rights reserved.

California Physician’s Service DBA Blue Shield of California is an independent member of the Blue Shield Association.

For Blue Shield Medicare Advantage Plans: Blue Shield of California is an HMO, HMO D-SNP, PPO and a PDP plan with a Medicare contract and a contract with the California State Medicaid Program. Enrollment in Blue Shield of California depends on contract renewal.

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© California Physicians' Service DBA Blue Shield of California 1999-2024. All rights reserved. California Physicians’ Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Health plans are offered by Blue Shield of California.

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