Blue Shield Rx Enhanced (PDP)
Contract S2468, plan 004, segment 0 · offered by CALIFORNIA PHYSICIANS' SERVICE · CMS PDP Region 32 (California).
Plan features
| Monthly premium | $227.80 |
|---|---|
| Annual deductible | $0.00 |
| Drug benefit type | Enhanced Alternative (EA) |
| $0 premium with full LIS | No |
| Premium with Extra Help (LIS) | — |
| Formulary drugs | 3,273 |
| Formulary exception tier | — |
| Mail order offered | — |
| Plan reach | — |
| Members in California | — |
| Members nationally | — |
| Member services | — |
| BIN / PCN | — |
CMS star ratings
- Summary rating
- 3 out of 5 stars for Summary rating
- Customer service
- —
- Member experience
- —
- Drug pricing & patient safety
- —
Formulary tiers — preferred pharmacy, initial coverage phase
| Tier | Cost-sharing | Drugs on tier |
|---|---|---|
| Tier 1 | $0.00 | — |
| Tier 2 | $7.00 | — |
| Tier 3 | 19% | — |
| Tier 4 | 37% | — |
| Tier 5 | 33% | — |
Cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $11.00 | n/a | $0.00 | $33.00 | $0.00 |
| Tier 2: Generic | $7.00 | $14.00 | n/a | $14.00 | $42.00 | $14.00 |
| Tier 3: Preferred Brand | 19% | 19% | n/a | 19% | 19% | 19% |
| Tier 4: Non-Preferred Drug | 37% | 37% | n/a | 37% | 37% | 37% |
| Tier 5: Specialty Tier | 33% | 33% | 33% | n/a | n/a | n/a |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Star rating measures
| Measure | 2026 | 2025 |
|---|---|---|
| Overall Star Rating | 3 | 3 |
| Summary Rating of Prescription Drug Plan Quality | 3 | 3 |
| Drug Plan Customer Service | 5 | 3 |
| Call Center — Foreign Language Interpreter and TTY Availability | 5 | 3 |
| Member Complaints and Changes in the Drug Plan’s Performance | 4 | 4 |
| Complaints about the Drug Plan (higher score is better - means fewer complaints) | 4 | 5 |
| Members Choosing to Leave the Plan (higher score is better - means fewer members leaving) | 3 | 4 |
| Improvement (if any) in the Drug Plan's Performance | 4 | 2 |
| Member Experience with the Drug Plan | 3 | 4 |
| Members’s Rating of Drug Plan | 3 | 3 |
| Ease of Getting Prescriptions Filled When Using the Plan | 2 | 4 |
| Drug Safety and Accuracy of Drug Pricing | 3 | 3 |
| Medicare.gov Plan Finder Drug Price Accuracy (higher score is better) | 4 | 3 |
| Medication Adherence for Diabetes Medications | 2 | 1 |
| Medication Adherence for Hypertension (RAS antagonists) | 2 | 2 |
| Medication Adherence for Cholesterol (Statins) | 2 | 2 |
| MTM Program Completion Rate for CMR | 5 | 5 |
| Statin Use in Persons with Diabetes | 3 | 2 |
Benefits in plain text
The following Medicare Prescription Drug plan (PDP) benefits apply to the Blue Shield Rx Enhanced (PDP) (S2468 - 004) in CMS Region 32 , which includes all counties in CA. This plan is administered by CALIFORNIA PHYSICIANS' SERVICE, a national plan provider. This means that the insurance carrier offers Medicare Part D plan in most every state. To switch to a different Medicare Prescription Drug plan or to change your location, click here. Click here to see the Blue Shield Rx Enhanced (PDP) prescription drug benefit details in chart format or email and view benefits chart Plan Premium The Blue Shield Rx Enhanced (PDP) has a monthly premium of $227.80. That is $2,733.60 for 12 months. There are a few factors that can increase or decrease this premium. If you qualify for extra help , your premium will be lower. If you have a premium penalty, your premium will be higher. Or if you have a higher income you would be subject to the Income Related Adjustment Amount (IRMAA) . Plan Membership and Plan Ratings The Blue Shield Rx Enhanced (PDP) (S2468 - 004) in CMS Region 32 currently has 27,797 members, and 27,797 members in the Blue Shield Rx Enhanced (PDP) nationwide. The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 3 stars. The detail CMS plan carrier ratings are as follows: Customer Service Rating of 5 out of 5 stars Member Experience Rating of 3 out of 5 stars Drug Cost Information Accuracy Rating of 3 out of 5 stars Prescription Drug Coverage: Deductible, Cost-sharing, Formulary This plan does NOT have a deductible for the prescription drug coverage. That means that you have first dollar coverage. Some plans have a deductible that must be paid (in full) prior to the prescription coverage assisting in your prescription costs (see cost-sharing below). The maximum deductible for 2026 is $615. This plan (Blue Shield Rx Enhanced (PDP)) has no deductible. The following information is about the Blue Shield Rx Enhanced (PDP) formulary (or drug list). There are 3263 drugs on the Blue Shield Rx Enhanced (PDP) formulary. The Blue Shield Rx Enhanced (PDP) does offer a mail order service . Click here to browse the Blue Shield Rx Enhanced (PDP) Formulary . The Initial Coverage Phase (ICP) can be thought of as the cost-sharing phase of the plan. During this phase, you and the insurance company share your prescription costs. Since this plan has no deductible, your coverage (initial coverage phase) will start right away. All medication are divided into tiers within the plans formulary. This helps the plan to organize and manage the prescription cost-sharing. The Blue Shield Rx Enhanced (PDP)’s formulary is divided into 5 tiers. Every plan can name their tiers differently, and can place medications on any tier. The cost-sharing for this plan is divided as follows: Tier 1 ( Preferred Generic ) contains 192 drugs and has a co-payment of $0.00 . Tier 2 ( Generic ) contains 838 drugs and has a co-payment of $7.00 . Tier 3 ( Preferred Brand ) contains 725 drugs and has a co-insurance of 19% of the drug cost. Tier 4 ( Non-Preferred Drug ) contains 889 drugs and has a co-insurance of 37% of the drug cost. Tier 5 ( Specialty Tier ) contains 629 drugs and has a co-insurance of 33% of the drug cost. All forms of insulin covered by this Medicare Part D plan will have a copay of $35 or less through all phases of coverage. Please contact the drug plan for more details. Click here to browse the Blue Shield Rx Enhanced (PDP) Formulary .