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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 (Advantage)

2022 formulary (Advantage QHDHP) - QHDHP and PersonalBlue plans

Advantage formulary

2022 opioid updates

Advantage formulary update

January 1, 2022 updates

2022 formulary (CHIP)

CHIP formulary

2022 CHIP opioid updates

CHIP formulary update

January 1, 2022 updates

2022 formulary (Value) - all plans except QHDHP plans

Value formulary

2022 Value opioid updates

Value formulary update

January 1, 2022 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.

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 for Value - January 1, 2022  
(includes vaccine coverage)

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


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 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.

Limited distribution specialty drugs - January 1, 2022

Insulin Saver Program - January 1, 2022

Oral chemotherapy medication listing - January 1, 2022

If you have Group coverage from your employer

Formulary (covered drug list)

Formulary updates

2022 formulary (Advantage)

Advantage formulary

2022 opioid updates

Advantage formulary update

January 1, 2022 updates

2022 formulary (Elite)1

Elite formulary

2022 Elite opioid updates

2022 formulary (Exclusive)1

Exclusive formulary

2022 Exclusive opioid updates

2022 formulary (Value Plus)

Value Plus formulary

2022 opioid updates

Value Plus formulary update

January 1, 2022 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

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 for Advantage - January 1, 2022  
(includes vaccine coverage)

PPACA for Exclusive - January 1, 2022  
(includes vaccine coverage)

PPACA for Value - January 1, 2022  
(includes vaccine coverage)

PPACA for Elite - January 1, 2022  
(includes vaccine coverage)

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


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.

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 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, 2022

Elite qualified high deductible health plan - January 1, 2022

Exclusive qualified high deductible health plan - January 1, 2022

Value Plus qualified high deductible health plan - January 1, 2022

Advantage - Value-Based Design drug list

Elite - Value-Based Design drug list

Exclusive - Value-Based Design drug list

Value Plus - Value-Based Design drug list

Limited distribution specialty drugs - January 1, 2022

Oral chemotherapy medication listing - January 1, 2022

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

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.