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 Blue Cross or Pennie

Formulary (covered drug list)

Formulary updates

2022 formulary (Value) - all plans except QHDHP plans

2021 formulary (Value)

Value formulary

2021 opioid updates

Value formulary update

January 1, 2022 updates

January 1, 2021 updates

April 1, 2021 updates

2022 formulary (Advantage Individual QHDHP) - QHDHP and PersonalBlue plans

N/A

2021 formulary (CHIP)

CHIP formulary

2021 opioid updates

CHIP formulary update

January 1, 2022 updates

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.

Additional offerings

The Insulin Saver Program offers preferred insulins that will be available to members at low or no cost share. This only applies for Individual accounts with the Value formulary, and does not apply to QHDHP plans.

The Value formulary has been enhanced with medications for certain classes of drugs that will be available to members at no cost share.

The oral chemotherapy medication list includes drugs on our Commercial formulary.

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

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

Insulin Saver Program - January 1, 2022

Value enhanced preventive medications - January 1, 2022

Oral chemotherapy medication listing

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

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

April 1, 2021 updates


PPACA preventive services

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

July updates

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

PPACA for Exclusive full - July 1, 2021 
(includes vaccine coverage)

PPACA for Exclusive lite - July 1, 2021 
(includes vaccine coverage)

PPACA for Elite full - July 1, 2021  
(includes vaccine coverage)

PPACA for Elite lite - July 1, 2021  
(includes vaccine coverage)


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

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

The prescription drug Value-Based Benefits program is designed to increase adherence to medications used to treat angina/arrhythmia, asthma, diabetes, diabetic supplies, high blood pressure/other cardiovascular conditions, and high cholesterol, which are available to you at a reduced cost. When taken regularly and as prescribed, medications to treat these conditions can increase your likelihood for healthier outcomes.

Additional offerings

The oral chemotherapy medication list includes drugs on our Commercial formulary.

Refer to the Value, Value Plus, Elite or Exclusive formularies for the medications included with those plans.

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

Advantage qualified high deductible health plan - July 1, 2021

Elite qualified high deductible health plan - July 1, 2021

Exclusive qualified high deductible health plan - July 1, 2021

Value Plus qualified high deductible health plan - July 1, 2021

Value Plus Value-Based Design drug list - July 2021

Value-Based Design drug list - 2021

Oral chemotherapy medication listing

Forms/lists

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 Blue Cross formularies. The formularies will reflect this shortly. Thank you for your patience.