Prescription Drug Benefits

Log in to your secure member account to see your prescription drug benefits.

Find a pharmacy in your network

Drug Lists and Forms


If you have:

Group Coverage From Your Employer or PersonalBlue PPO

Individual Coverage From Capital BlueCross or

Drug Formulary
2018 Formulary (Open/Closed)
2019 Formulary (Open/Closed)
2018 Selectively Closed Formulary 
2019 Selectively Closed Formulary
Formulary Updates

Open/Closed Formulary


Selectively Closed Formulary


Prior Authorization, Enhanced Prior Authorization (Step Therapy), Quantity Level Limits, and Specialty Medication Lists
2018 Pharmacy Benefit Information (for open/closed formulary) 2018 Pharmacy Benefit Information (for selectively closed formulary)
Preventive Services

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

Preventive Medications 
(PPACA and vaccine coverage)
Preventive Medications
(PPACA and vaccine coverage)
Blood Glucose Meter Program
Blood Glucose Meters
General Forms
Prescription Claim Form
Mail Orders

Mail Order Form (English)

Mail Order Form (Español)

On behalf of Capital BlueCross, CVS/caremark™ assists in the administration of our prescription drug program. CVS/caremark is an independent pharmacy benefit manager.

On behalf of Capital BlueCross, AllianceRx Walgreens Prime, an independent company by Walgreens Specialty Pharmacy Holdings, LLC, assists in dispensing specialty medications for our members.