Prescription drug benefits

Visit your secure account to see prescription drug benefits, check costs or start home delivery.

Find a pharmacy in your network

Formulary (covered drug list)

If you have individual coverage from Capital BlueCross or HealthCare.gov

Formulary (covered drug list)

Formulary updates

2021 formulary (Value)

Value formulary

2021 opioid updates

Value formulary update

January 1, 2021 updates

April 1, 2021 updates

2021 formulary (CHIP)

CHIP formulary

2021 opioid updates

CHIP formulary update

January 1, 2021 updates

April 1, 2021 updates


Formulary requirements/ 
Guide to prescription drug benefits

Here you’ll find lists of drugs that have special requirements before they are covered by your plan, and an overview of how to use your prescription drug benefits

PPACA Preventive Services

Some preventive medications may be covered at no cost to you when filled at a participating pharmacy with a valid prescription.

Prior Authorization, Step Therapy (ST), Quantity Level Limits, and Specialty Medication Lists

PPACA Preventive Medications - January 1, 2021  
(includes vaccine coverage)

If you have Group coverage from your employer or PersonalBlue PPO

Formulary (covered drug list)

Formulary updates

2021 formulary (Advantage)

Advantage formulary

2021 opioid updates

Advantage formulary update

January 1, 2021 updates

April 1, 2021 updates

2021 formulary (Elite)1

 

2021 formulary (Exclusive)1

 

2021 formulary (Value)

 

2021 formulary (Value Plus)

Value Plus formulary

2021 opioid updates

Value Plus formulary update

January 1, 2021 updates

April 1, 2021 updates


Formulary requirements/ 
Guide to prescription drug benefits

Here you’ll find lists of drugs that have special requirements before they are covered by your plan, and an overview of how to use your prescription drug benefits

PPACA Preventive Services

Some preventive medications may be covered at no cost to you when filled at a participating pharmacy with a valid prescription.

QHDHP Preventive Drugs

(This option is available to large groups of 100+ employees and is standard for all groups of less than 100 employees.)

Check your Certificate of Coverage to see if this option applies to your QHDHP. If so, some preventive and maintenance medications will have the deductible waived, and you will be charged only a copay.

Value-Based Design drug list

Prior Authorization, Step Therapy (ST), Quantity Level Limits, and Specialty Medication Lists

PPACA Preventive Medications - January 1, 2021  
(includes vaccine coverage)

PPACA for Elite/Exclusive - July 1, 2020 
(includes vaccine coverage)

2021 Qualified High Deductible Health Plan - January 1, 2021

2021 Value-Based Design drug list

Forms/lists

Oral chemotherapy medication
Oral chemotherapy medication listing
Blood Glucose Meter Program
Blood glucose meters
CHIP prescription claim

CHIP prescription claim form

General forms
Prescription claim form
Mail orders

Mail order form

1OneTouch and LifeScan products are now brand preferred products on all Capital BlueCross formularies. The formularies will reflect this shortly. Thank you for your patience.