Value and CHIP formulary update
(2nd and 3rd quarter 2020 effective January 1, 2021)
The Capital Blue Cross formulary is a reference list of prescription drugs that contains a wide range of generic and brand drugs that have been approved by the U.S. Food and Drug Administration (FDA). The formulary is updated on a quarterly basis or when new generic or brand-name medications become available and as discontinued drugs are removed from the marketplace.
A Value formulary provides access to generic, brand preferred and select brand non-preferred medications. Under a Closed formulary, only select brand non-preferred drugs (non-formulary drugs) are covered unless approved via a Non-Formulary Consideration Process. The provider may request that coverage be granted when medically necessary. The Non-Formulary Consideration Process may require the trial and failure of 2 formulary alternatives (if 2 are available) prior to approval of the non-formulary medication. Approvals will be member-and drug-specific. Each unique non-formulary drug exception must be reviewed and approved separately.
Pharmacy Management Program update
(PAR) = Prior authorization required
(EPA) = Enhanced prior authorization required
(QLL) = Quantity level limits apply — Quantity Level Limit (QLL) Program
(BP) = Brand preferred
(BNP) = Brand non-preferred
(NC) = Not covered
(NF) = Non-Formulary
UPPERCASE names = Brand
lowercase names = Generic
Quantity Level Limit (QLL) Program
Effective January 1, 2021
The following medications have been added to the Quantity Level Limits (QLL) Program.
FREESTYLE LIBRE 2 READER
1 Quantity/365 Days
FREESTYLE LIBRE 2 SENSOR
2 Quantity/28 Days
1Indicates specialty medication.
Impacted members will be notified prior to change.