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|
|ADVATE||Prior authorization for medical necessity and dispensing may be required.||P||07/01/19|
|ADVICOR®||Advicor may be subject to step therapy requirements. Patients must have trial and failure of generic statin (lovastatin, pravastatin, simvastatin).||P||01/01/11|
|ADYNOVATE||Prior authorization for medical necessity and dispensing may be required.||P||07/01/19|
|Adzenys ER||The limits are 15mLs for the 1.25 mg/1mL solution.||P||04/01/18|
|ADZENYS XR-ODT||The limits are 2 tablets per day for the 3.1mg and 6.3mg tablets. The limits are 1 tablet per day for the 9.4 mg, 12.5 mg, 15.7 mg, 18.8 mg tablets.||P||07/01/16|
|AEROSPAN®||The limits are 2 canisters per month.||P||04/01/14|
|AFINITOR®||Prior authorization for medical necessity is required. The limits are 1 tablet per day.||P||07/20/09||07/01/11|
|AFINITOR® DISPERZ||Prior authorization for medical necessity is required. The limits are 2 tablets per day, except the 3 mg tablets which have a limit of 3 tablets per day.||P||07/01/13|
|AFREZZA®||Prior authorization for medical necessity is required. The limits are 2,520 cartridges per 30 days for the 4 unit pack, 1,530 cartridges per 30 days for the 30 x 4 unit mix pack, 1,890 cartridges per 30 days for the 60 x 4 unit mix pack, 1,080 cartridges per 30 days for the 60 x 8 unit mix pack, and 1,800 cartridges per 30 days for the 90 x 4 unit mix pack. The limits are 1,080 cartridges per 30 days for the 90 x 8 unit and 90 x 12 unit cartridge packs.||P||01/22/15||04/01/19|
|AFSTYLA||Prior authorization for medical necessity and dispensing may be required.||P||07/01/19|
|AIMOVIG||Prior authorization for medical ncessity is required. The limits are 1 injection per month.||P||07/01/19|
|AJOVY||Prior authorization for medical necessity is required. The limits are 3 syringes every 90 days.||P||01/01/19|
|AKYNZEO®||The limits are 2 capsules per 30 days.||P||01/01/15|
|AKYNZEO® IV||Prior authorization for medical necessity is required.||M||07/01/18|
|ALDARA||Prior Authorization is required for medical necessity. The limits are 12 packets per month for up to 4 months for External genital and perianal warts or Actinic keratosis. The limits are 24 packets per month for up to 2 months for superficial basal cell carcinoma.||P||10/01/16|