CurrentCapital BluecrossPolicy N/A
2026 Exclusive Full DRUG LIST (Formulary)
Capital Blue Cross Exclusive Full Formulary listing covered prescription drugs, tier placement, specialty designation, and utilization management indicators (prior authorization, step therapy, quantity limits, limited distribution) for fully insured individual and employer group plans in Pennsylvania.
Policy Summary
PayerCapital Bluecross
Policy2026 Exclusive Full DRUG LIST (Formulary)
Policy CodePolicy N/A
Change TypeNo material change
Effective Date
Next Review Date
Key ActionIf a drug's Prior Authorization column shows an indicator (dot), the provider must submit a prior authorization request for coverage approval before the drug will be covered.
POLICY UPDATE CHANGES
No material clinical or coverage changes noted in this brief (has_material_change=false).
multipleTherapeutic classes
~150+Drug entries (approx.)
multiplePA flagged items
multipleLimited Distribution items
70+Vaccine entries
Coverage Summary
General Formulary Coverage Criteria
This fragment of the Capital Blue Cross 2026 Exclusive Full Drug List (Formulary) summarizes the formulary coverage stance and scope for the plan. It describes what the formulary covers and the plan-level boundaries for covered prescription drugs.
Covered when ALL of the following are met:
AND
The drug is a prescription medication that is FDA‑approved (NDA, ANDA, or BLA) OR coverage is required by law or specific group benefit (for example, PPACA preventive drugs).
AND
The drug is included on the Capital Blue Cross Exclusive Full Formulary or a nonformulary exception is approved.
Policy Summary
PayerCapital Bluecross
Policy2026 Exclusive Full DRUG LIST (Formulary)
Policy CodePolicy N/A
Change TypeNo material change
Effective Date
Next Review Date
Key ActionIf a drug's Prior Authorization column shows an indicator (dot), the provider must submit a prior authorization request for coverage approval before the drug will be covered.
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