It is good practice to verify that your medications are on the Blue Shield formulary.
Health insurance companies hold down the costs of healthcare by creating a list of drugs called a “formulary” that are clinically- and cost-effective. Each insurance company has a different formulary. Let’s check to see if your medications are on the Blue Shield of California formulary.
You will often see four categories of medications:
- Generic or tier 1($).
Insurance companies want to encourage you to use generics when possible and thus they are the least expensive.
- Preferred brand or tier 2 ($$).
These are often the older, time-tested brand name drugs and have lower costs. Insurance companies hope you will use preferred brand drugs instead of these non-preferred drugs.
- Non-preferred brand or tier 3 ($$$).
These are often the newer medications and thus are more expensive.
- Specialty or tier 4 ($$$$)
These are the newest and most expensive medication, and often include injectable drugs.
View a full formulary list here:
Note: Be sure to read the first few pages of the drug formulary so you understand how it works. Since this list of medications is quite large, use the search function (e.g., Control-F) to find your specific medication.