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|
|AMERGE®||Amerge may be subject to step therapy. Patients must have trial and failure of a generic triptan (naratriptan, sumatriptan, rizatriptan). The limits are 18 tablets per 30 days.||P||11/01/05||07/01/15|
|AMITIZA®||Prior authorization for medical necessity is required.||P||09/01/06||10/01/11|
|AMPYRA®||Prior authorization for medical necessity is required. The limits are 2 tablets per day.||P||06/01/10|
|AMTURNIDE®||Amturnide may be subject to step therapy requirements. Patients must have trial and failure of a generic ACE inhibitor or generic ARB.||P||04/01/11||10/01/15|
|ANDRODERM®||Prior authorization for medical necessity is required. The limits are 1 patch per day.||P||07/20/09||07/01/16|
|ANDROGEL®||Prior authorization for medical necessity is required. The limits are two cartons (60 packets) of 2.5 gram or 5 gram unit-dose packets per 30 days. The Androgel Pump has a limit of 4 pumps (300 grams) per 30 days. Androgel 1.62% has a limit of 2 bottles (150 grams), 30 1.25 gm packets, or 60 2.5 gm packets per 30 days.||P||06/15/04||07/01/16|
|ANORO ELLIPTA||The limits are 60 doses per 30 days.||P||04/01/14|
|ANZEMET®||The limits are 7 tablet per 30 days.||P||02/01/05||04/01/12|
|APADAZ||Prior authorization for medical necessity is required. The limits are 12 tablets per day for 4.08-325mg, 6.12-325mg and 8.16-325mg tablets.||P||04/01/19|
|APIDRA®||Apidra may be subject to prior authorization. Patients must have trial and failure of Novolog.||P||01/01/15|
|APLENZIN®||The limits are 1 tablet per day.||P||08/06/08|
|APTENSIO XR®||The limits are 1 capsule per day.||P||07/01/15|
|APTIVUS||The limits are 4 capsules or 13 mL per day, or 380mL per 30 days.||P||07/01/12|
|ARCALYST||Prior authorization for medical necessity is required. Patients must be at least 12 years of age. The limits are four 220 mg vial per 28 days.||P||12/18/08||10/01/15|
|ARCAPTA®||The limits are 30 capsules per 30 days.||P||01/01/12|