Drug coverage is limited to prescription products approved by the Food and Drug Administration as evidenced by a New Drug Application (NDA), Abbreviated New Drug Application (ANDA), or Biologics Licensed Application (BLA) on file. Any legal requirements or group specific benefits for coverage will supersede this (e.g. preventive drugs per the Affordable Care Act).
Drug coverage may also be subject to policy guidelines established by Blue Cross and Blue Shield of Alabama. Drug coverage policies are not intended to dictate to physicians how to practice medicine. Physicians should exercise their medical judgment in providing the care they feel is most appropriate for their patients.
Please note: Some employer groups may have specific drug coverage requirements for their employees that are not included in the criteria below.
Drug Coverage Guidelines
Search by Drug Name
|Product Name||Guideline||Coverage Benefit*||Implementation Date||Change Date|
|ACTONEL®||The limits are 1 tablet per day for Actonel 5mg and 30mg, 4 tablets per 28 days for 35mg, and 1 tablet per month for 150mg.||P||01/01/00||01/01/18|
|ACTOPLUS MET XR®||The limits are 2 tablets per day for Actoplus Met XR 15/1000mg and 1 tablet per day for Actoplus Met XT 30/1000mg.||P||01/01/11|
|ACTOPLUS MET®||The limits are 3 tablets per day.||P||08/06/08|
|ACTOS®||The limits are 1 tablet per day.||P||07/01/10||04/01/12|
|ADCETRIS®||Prior authorization for medical necessity is required.||M||01/01/15||04/01/16|
|ADCIRCA®||Prior authorization for medical necessity is required. The limits are 2 tablets per day.||P||04/01/15|
|ADDERALL||The limits are 2 tablets per day except for Adderall 15mg which has a limit of 3 tablets per day.||P||10/01/16||01/01/18|
|ADDERALL XR||The limits are 1 capsule per day.||P||11/13/02||10/01/16|
|ADDYI||Prior authorization for medical necessity is required. Addyi has a limit of 1 tablet per day.||P||01/01/16||01/01/17|
|ADEMPAS®||Prior authorization for medical necessity is required. The limits are 3 tablets per day.||P||04/01/15|
|ADIPEX-P||Prior authorization for medical necessity is required. The limits are 1 capsule/tablet per day.||P||07/01/19|
|ADLYXIN||Adlyxin maybe subject to step therapy requirements and quantity limits. The limits are 2 pens per 28 days and 1 starter pack (2 pens) per 180 days.||P||07/01/17|
|Admelo||May be subject to prior authorization. Patients must have trial and failure of Novolog.||P||04/01/18|
|ADOXA®||Adoxa may be subject to step therapy requirements. Patients must have trial and failure of generic immediate release doxycycline AND generic immediate release minocycline.||P||04/01/13||01/01/15|
|ADVAIR®||Advair Diskus has a limit of 1 package(60 blisters) per month. Advair HFA has a limit of 1 inhaler per 30 days.||P||08/06/08||04/01/19|