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|
|EDARBI®||Edarbi 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|
|EDARBYCLOR®||Edarbyclor may be subject to step therapy requirements. Patients must have trial and failure of a generic ACE inhibitor or generic ARB.||P||07/01/12||10/01/15|
|EDEX®||Prior authorization for medical necessity may be required. Patients must be at least 18 years of age.||P||07/01/10|
|EDLUAR®||The limits are 1 tablet per day.||P||07/06/09||07/01/13|
|EDURANT||The limits are 1 tablet per day.||P||07/01/12|
|EFFEXOR||The limits are 3 tablets per day.||P||10/01/16|
|EFFEXOR XR®||The limits are 1 capsule per day, except Effexor XR 75mg which has a limit of 3 capsules per day.||P||07/01/05||02/13/08|
|EFINACONAZOLE||Prior authorization for medical necessity is required. The limits are 4ml per 30 days.||P||07/01/16|
|EFUDEX||Prior Authorization is required for medical necessity. The limits will vary based on the disease being treated.||P||10/01/16|
|ELAPRASE||Prior authorization for medical necessity is required.||M||07/01/18|
|ELELYSO||Prior authorization for medical necessity is required.||M||07/01/18|
|ELESTRIN||The limits are 1 pump per 30 days.||P||04/01/19|
|ELIDEL®||Elidel may be subject to step therapy requirements. Patients must have trial and failure of a topical corticosteriod or topical corticosteroid combination preparation.||P||10/01/18|
|ELIQUIS||The limits are 2 tablets per day for Eliquis 2.5mg and 4 tablets per day for Eliqus 5 mg.||P||07/01/13||10/01/14|
|ELMIRON||Prior authorization is required for medical necessity.||P||04/01/19|