Outpatient drug formulary

The Blue Shield Drug Formulary is designed to assist physicians in prescribing medically appropriate, cost-effective drug therapy. In selecting medications for the formulary, the Blue Shield of Pharmacy and Therapeutics (P&T) Committee considers safety, efficacy, FDA bioequivalency data and then cost. Maintenance of the formulary is a responsibility of the P&T Committee.

You may search the drug formulary by generic or brand name or by therapeutic category.

 Blue Shield of California IFP, Small Group Large Group and Medicare formularies

 Blue Shield of California Promise Health Plan Cal MediConnect formulary

New drugs and clinical data are reviewed quarterly to update the formulary. Drugs are also considered for removal if a new, equivalent, cost-effective alternative is added to the formulary, or if new clinical information pertaining to adverse drug effects is reported. Drugs that have been previously reviewed may be re-reviewed to consider updated FDA approval information and recent clinical trials supporting use of the drug.

Comments, questions and requests for formulary additions are encouraged and should be directed to:

 Blue Shield Pharmacy and Therapeutics Committee
      c/o Pharmacy Services Department
      P.O. Box 7168
      San Francisco, CA 94120-7168
  Phone:(800) 535-9481
  Fax: (888) 697-8122

Pharmacy benefit design

Find details of the pharmacy benefit, including formulary, medication supply, injectable drug coverage and exclusions.

Learn more about pharmacy benefits

Mail service pharmacy

Get information about CVS Caremark Mail Service, a full-service home delivery pharmacy providing Blue Shield of California members with mail service prescription services.

Learn more about mail service pharmacy

Generic drug policy

Read a description of Blue Shield of California policy regarding prescription of generic drugs and criteria they must meet to be included in the formulary.

Read about generic drug policy

Drug prior authorization forms

Download and print prior authorization forms for oral, topical and home self-administered injectable prescription drugs.

Find forms for Blue Shield IFP, Small, Large Group and Medicare members

Find forms for Blue Shield Promise Medicare, Medi-Cal and Cal MediConnect members

Medication policy

Read about our medication policy for injectable and office-administered drugs.

View medication policy

Online pharmacy authorization request

Submit your pharmacy authorization request for Blue Shield IFP, Small, Large Group and Medicare member online via AuthAccel.

Request pharmacy authorization

Medical specialty drug resources

Access drop ship medication list, preferred specialty drug list for medication benefits and more.

Medical specialty drug resources

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