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|
|ALDURAZYME||Prior authorization for medical necessity is required.||M||07/01/18|
|ALECENSA®||Prior authorization for medical necessity is required. The quantity limits are 8 capsules per day.||P||04/01/16|
|ALENDRONATE||The limits are 1 tablet per day for 10mg and 40mg tablets. The 35mg and 70mg tablet blister packs are limited to 1 per 28 days. The oral solution is limited to 300mls per 28 days.||P||07/01/13||01/01/14|
|ALIMTA®||Prior authorization for medical necessity is required.||M||05/01/16|
|ALLZITAL®||The limits are 12 tablets per day||P||07/01/16|
|ALORA||The limits are 8 patches per 28 days.||P||04/01/19|
|ALOXI®||Prior authorization for medical necessity is required.||M||01/01/15||04/01/16|
|ALPHANATE||Prior authorization for medical necessity and dispensing may be required.||P||07/01/19|
|ALPHANATE SD||Prior authorization for medical necessity and dispensing may be required.||P||07/01/19|
|ALPROLIX||Prior authorization for medical necessity and dispensing may be required.||P||07/01/19|
|ALTOPREV®||Altoprev may be subject to step therapy requirements. Patients must have trial and failure of generic statin (lovastatin, pravastatin, simvastatin).||P||01/01/11|
|ALUNBRIG||Prior authorization for medical necessity is required. The quantity limits are 6 tablets per day for the 30mg tablets; 1 tablet per day for the 90mg and 180 mg tablets; or 1 pack per 180 days for the PAK.||P||04/01/18|
|ALVESCO®||The limits are 1 box per 30 days for 80mcg strength and 2 boxes per 30 days for 160mcg strength.||P||08/06/08||04/01/11|
|AMBIEN CR®||The limits are 1 tablet per day.||P||10/01/05||07/01/13|
|AMBIEN®||The limits are 1 tablet per day.||P||02/25/02||07/01/13|