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|
|CABOMETYX™||Prior authorization for medical necessity is required. The limits are 1 tablet per day.||P||07/01/16|
|CADUET®||Only 1 statin covered per month.||P||01/01/00|
|CALQUENCE||Prior authorization for medical necessity is required. The limits are 2 capsules per day.||P||09/01/17|
|CAPITAL® AND CODEINE||The limit is 90mLs per day of the 120 mg/12 mg/5 mL suspension per day.||P||04/01/11||04/01/18|
|CAPRELSA®||Prior authorization for medical necessity is required. The limits are 2 tablets per day for the 100mg tablets and 1 tablet per day for the 300mg tablets.||P||01/01/12|
|CARAC||Prior Authorization is required for medical necessity. The limits are one 30 gram tube per month.||P||10/01/16||04/01/18|
|CARAFATE||Prior authorization for medical necessity is required. The limits are 40mls per day.||P||04/01/19|
|CARBAGLU||Prior authorization for medical necessity is required.||P||10/01/17|
|CARIMUNE® NF||Prior authorization for medical necessity is required.||M||01/01/15||04/01/16|
|CAVERJECT®||Prior authorization for medical necessity may be required. Patients must be at least 18 years of age.||P||07/01/10|
|CAVERJECT® IMPULSE||Prior authorization for medical necessity may be required. Patients must be at least 18 years of age.||P||07/01/10|
|CAYSTON®||Prior authorization for medical necessity may be required. Must not be used concurrently with inhaled tobramycin or Bethkis.||P||04/01/12||04/01/13|
|CELEBREX®||The limits are 2 capsules per day, except Celebrex 400mg which has a limit of 1 capsule per day.||P||01/01/00||01/01/12|
|CELEXA||The limits are 1 tablet per day for the 10 mg, 20 mg, and 40 mg tablets. The limits are 600 mLs per 30 days for the oral solution.||P||10/01/16|
|CERDELGA||Prior authorization for medical necessity is required. The limits are 2 capsules per day.||P||10/01/17|