Blue Shield Rx Plus (PDP)

Important Message About What You Pay for Vaccines

Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible. Call Customer Service for more information.

Important Message About What You Pay for Insulin

You 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 you haven’t paid your deductible.

Printable Files

The following files require Adobe Acrobat. Download Adobe Acrobat

• Summary of 2025 Formulary Changes
• Printable Formulary
• Spanish Formulary
• Prior Authorization Criteria
• Step Therapy Criteria

How to Search For Drugs

• Search by typing part of the generic (chemical) and brand (trade) names.
• Search by selecting the therapeutic class of the medication you are looking for.

If your drug is not included in this formulary, please contact Customer Service and ask if your drug is covered.

If you learn that our plan does not cover your drug, you can ask for an exception to cover your drug. Please see Exceptions and Appeals for more information about how to request an exception.

Y0118_24_461A_C 08092024 H2819_24_461A_C Accepted 08262024  

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Contact number: (888) 239-6469 TTY: 711

Reach us 8:00 a.m. – 8:00 p.m., seven days a week.

Blue Shield of California
601 12th Street, Oakland, CA 94607

For assistance in English at no cost, call the toll-free number on your ID card. You can get this document translated and in other formats, such as large print, braille, and/or audio, also at no cost. Para obtener ayuda en español sin costo, llame al número de teléfono gratis que aparece en su tarjeta de identificación. También puede obtener gratis este documento en otro idioma y en otros formatos, tales como letra grande, braille y/o audio.   如欲免費獲取中文協助，請撥打您ID 卡上的免費電話號碼。您也可免費獲得此文件的譯文或其他格式版本，例如：大字版、盲文版和/或音訊版  

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