Value and CHIP formulary update

(2nd and 3rd quarter 2021 effective January 1, 2022)

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.

The Capital Blue Cross Closed formulary serves as a reference for Exchange/Marketplace prescription drug benefit designs.

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.

The following medications have been added to the Quantity level limits (QLL) program.

Quantity level limit (QLL) program

Effective January 1, 2022

Impacted members will be notified prior to change