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

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.

Additional offerings

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

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

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

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

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

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


PPACA preventive services

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

January updates

July updates

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

PPACA for Elite/Exclusive - January 1, 2021 
(includes vaccine coverage)

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

Additional offerings

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

Advantage qualified high deductible health plan - July 1, 2021

Advantage qualified high deductible health plan - January 1, 2021

Elite and Exclusive qualified high deductible health plan - January 1, 2021.

2021 Value-Based Design drug list

Elite and Exclusive Value Based Benefit - January 1, 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.