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To address the ongoing shortage of certain drugs used to treat attention deficit/ hyperactivity disorder (ADD/ADHD), Capital is temporarily expanding the covered drugs for these disorders.

Questions about your prescription drug benefits?

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

To confirm your plan's formulary, you can contact your employer, check your Benefits Booklet (Certificate of Coverage), or call Member Services using the number on the back of your ID card.

A PDF version of the formularies is available upon request by calling the Member Services phone number on the back of your ID card.

Find a pharmacy in your network

Formulary (drug list)

If you have CHIP coverage from Capital Blue Cross

Formulary (drug list)

Formulary updates

2024 formulary (CHIP)

CHIP formulary

January 1, 2024 opioid updates

CHIP formulary update

January 1, 2024 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.

ACA Copay Waiver

Capital Blue Cross offers a standard cost-share waiver policy that is applied across all Affordable Care Act categories.

ACA copay waiver form

Under the Biden Administration’s Inflation Reduction Act, beginning October 1, 2023, ACIP-recommended vaccines will be covered without cost-sharing for adults (aged 19 and older) enrolled in CHIP.

PPACA for CHIP - January 1, 2024
(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

If you’re uncertain which formulary applies to you, please check your plan documents, or call the Member Services number on the back of your ID card.

Providers can complete a Prescription Prior Auth through Cover My Meds.

Members please call the number on the back of your ID card to request a copy of a pharmacy clinical policy.

If your provider would like to discuss a pharmacy denial with a physician reviewer, they may call our clinical review department toll free at 866.230.7269.

Clinical pharmacy policies - Prior authorization

Clinical pharmacy policies - Quantity limits

Clinical pharmacy policies - Step therapy

2024 Guide to prescription drug benefits overview

If you have individual PersonalBlue PPO coverage from Capital Blue Cross

Formulary (drug list)

Formulary updates

2024 formulary (Advantage)

Advantage formulary

January 1, 2024 opioid updates

Advantage formulary update

January 1, 2024 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.

ACA Copay Waiver

Capital Blue Cross offers a standard cost-share waiver policy that is applied across all Affordable Care Act categories.

ACA copay waiver form

PPACA for Advantage - January 1, 2024
(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

If you’re uncertain which formulary applies to you, please check your plan documents, or call the Member Services number on the back of your ID card.

Providers can complete a Prescription Prior Auth through Cover My Meds.

Members please call the number on the back of your ID card to request a copy of a pharmacy clinical policy.

If your provider would like to discuss a pharmacy denial with a physician reviewer, they may call our clinical review department toll free at 866.230.7269.

Clinical pharmacy policies - Prior authorization

Clinical pharmacy policies - Quantity limits

Clinical pharmacy policies - Step therapy

2024 Guide to prescription drug benefits overview

Advantage January 2024

If you have individual coverage from Capital Blue Cross or Pennie

Formulary (drug list)

Formulary updates

2024 Formulary (Value)

Value formulary

January 1, 2024 opioid updates

Value formulary update

January 1, 2024 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.

ACA Copay Waiver

Capital Blue Cross offers a standard cost-share waiver policy that is applied across all Affordable Care Act categories.

ACA copay waiver form

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

If you’re uncertain which formulary applies to you, please check your plan documents, or call the Member Services number on the back of your ID card.

Providers can complete a Prescription Prior Auth through Cover My Meds.

Members please call the number on the back of your ID card to request a copy of a pharmacy clinical policy.

If your provider would like to discuss a pharmacy denial with a physician reviewer, they may call our clinical review department toll free at 866.230.7269.

Clinical pharmacy policies - Prior authorization

Clinical pharmacy policies - Quantity limits

Clinical pharmacy policies - Step therapy

PPACA for Value - January 1, 2024
(includes vaccine coverage)

2024 Guide to prescription drug benefits overview

Value January 2024


Limited distribution specialty drugs

This drug list includes drugs on our Commercial formulary. Limited distribution (LD) meaning there is a restriction on which pharmacies can dispense them. This limits where the member may obtain the prescription. Members may be required to use another pharmacy for limited distribution prescription drugs.

Additional offerings

The Enhanced zero dollar drug list includes drugs on our Value Formulary offered at no cost share. This list is not a complete list and does not contain any prior authorization, step therapy or quantity level limit requirements. The Enhanced zero dollar drug list is only applicable to Individual Accounts (non-QHDHP).

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 maintenance drug list includes drugs that are commonly used to treat conditions that are considered chronic or long-term such as high cholesterol, high blood pressure, asthma, diabetes, or heart disease.

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

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

Limited distribution specialty drugs - January 1, 2024

Enhanced zero dollar drug list - January 1, 2024

Insulin Saver Program - January 1, 2024

Maintenance drug list - January 1, 2024

Oral chemotherapy medication listing - January 1, 2024

If you have Group coverage from your employer

Formulary (drug list)

Formulary updates

2024 formulary (Advantage)

Advantage formulary

January 1, 2024 opioid updates

Advantage formulary update

January 1, 2024 updates

2024 formulary (Elite)

Elite formulary

January 1, 2024 opioid updates

Elite formulary update

January 1, 2024 updates

2024 formulary (Exclusive)

Exclusive formulary

January 1, 2024 opioid updates

Exclusive formulary update

January 1, 2024 updates

2024 Formulary (Value)

Value formulary

January 1, 2024 opioid updates

Value formulary update

January 1, 2024 update

2024 formulary (Value Plus)

Value Plus formulary

January 1, 2024 opioid updates

Value Plus formulary update

January 1, 2024 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.

If you’re uncertain which formulary applies to you, please check your plan documents, or call the Member Services number on the back of your ID card.

Providers can complete a Prescription Prior Auth through Cover My Meds.

Members please call the number on the back of your ID card to request a copy of a pharmacy clinical policy.

If your provider would like to discuss a pharmacy denial with a physician reviewer, they may call our clinical review department toll free at 866.230.7269.

Clinical pharmacy policies - Prior authorization

Clinical pharmacy policies - Quantity limits

Clinical pharmacy policies - Step therapy

PPACA preventive services

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

ACA Copay Waiver

Capital Blue Cross offers a standard cost-share waiver policy that is applied across all Affordable Care Act categories.

ACA copay waiver form

2024 Guide to prescription drug benefits overview

Advantage January 2024

Elite January 2024

Exclusive January 2024

Value January 2024

Value Plus January 2024

PPACA for Advantage - January 1, 2024  
(includes vaccine coverage)

PPACA for Elite - January 1, 2024    
(includes vaccine coverage)

PPACA for Exclusive - January 1, 2024  
(includes vaccine coverage)

PPACA for Value - January 1, 2024  

(includes vaccine coverage)

PPACA for Value Plus - January 1, 2024  

(includes vaccine coverage)


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

Due to a drug list update the following drugs are being removed from the QHDHP List effective January 1, 2024. This list of removed drugs is inclusive of all of the QHDHP collaterals and is subject to change. 2024 QHDHP drug removal list.

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.

Limited distribution specialty drugs

This drug list includes drugs on our Commercial formulary. Limited distribution (LD) meaning there is a restriction on which pharmacies can dispense them. This limits where the member may obtain the prescription. Members may be required to use another pharmacy for limited distribution prescription drugs.

Additional offerings

The Enhanced zero dollar drug list includes drugs on our Value Formulary offered at no cost share. This list is not a complete list and does not contain any prior authorization, step therapy or quantity level limit requirements. The Enhanced Zero Dollar Drug List is only applicable to Individual Accounts (non-QHDHP).

The Maintenance Drug List includes drugs that are commonly used to treat conditions that are considered chronic or long-term such as high cholesterol, high blood pressure, asthma, diabetes, or heart disease.

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.

Advantage qualified high deductible health plan - January 1, 2024

Elite qualified high deductible health plan - January 1, 2024

Exclusive qualified high deductible health plan - January 1, 2024

Value Plus qualified high deductible health plan - January 1, 2024

Advantage - Value-Based Design drug list - January 1, 2024

Elite - Value-Based Design drug list - January 1, 2024

Exclusive - Value-Based Design drug list - January 1, 2024

Value Plus - Value-Based Design drug list - January 1, 2024

Limited distribution specialty drugs - January 1, 2024

Enhanced zero dollar drug list - January 1, 2024

Maintenance drug list - January 1, 2024

Oral chemotherapy medication listing - January 1, 2024

Forms/lists

Blood Glucose Meter Program
Blood glucose meters
CHIP prescription claim

CHIP prescription claim form

General forms
Prescription claim form
Mail orders

Express Scripts home delivery form

1Capital Blue Cross is providing information about Mark Cuban Cost Plus Drug Company as a service to our members and the community in furtherance of Capital's mission and purpose. Capital does not in any manner endorse, assume responsibility for, or recommend the use of any drug or pharmacy described by Mark Cuban Cost Plus Drug Company. Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association serving 21 counties in Central Pennsylvania and the Lehigh Valley.