https://capitalbluecross.widen.net/s/wpgxljx9hp/rx-193_jan2024elitefullformularypreface
The listing of a drug in this formulary or search result is not a guarantee of coverage or payment. Please check your Benefit Booklet (or Certificate of Coverage) to verify coverage of a drug (for example, weight loss, sexual function, and fertility drugs) and for details about your benefits. Drug benefits and claim payments are subject to your drug plan’s specific terms and conditions, including eligibility and medical necessity determinations.
Capital Blue Cross is an Independent Licensee of the Blue Cross Blue Shield Association.