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|
|FABIOR||Prior authorization for medical necessity may be required.||P||07/01/13|
|FABRAZYME||Prior authorization for medical necessity is required.||M||07/01/18|
|FANAPT||Fanapt may be subject to step therapy requirements. Patients must have trial and failure of a generic atypical antipsychotic. The limits are 2 capsules per day for the 1 mg, 2 mg, 4mg, 6 mg, 8mg ,10mg ,12 mg tablets. The limits are 1 pack per 180 days for the titration pack.||P||07/01/16|
|FARXIGA®||The limits are 1 tablet per day.||P||04/01/14|
|FARYDAK®||Prior authorization for medical necessity is required. The limits are 6 capsules per 21 days.||P||07/01/15||04/01/18|
|FASENRA||Prior authorization for medical necessity is required.||M||11/14/17||02/01/18|
|FASLODEX®||Prior authorization for medical necessity is required.||M||10/01/19|
|FazaClo||FazaClo may be subject to step therapy requirements. Patients must have trial and failure of a generic atypical antipsychotic. The limits are 3 tablets per day for the 12.5mg tablet; 9 tablets per day for the 25mg tablet; 3 tablets of the 100 mg; 6 tablets per day of the 150mg; 4 tablets per day of the 200 mg tablets.||P||07/01/16||04/01/18|
|FEIBA NF/VF||Prior authorization for medical necessity and dispensing may be required.||P||07/01/19|
|FEMRING||The limits are 1 ring per 90 days for all strings.||P||04/01/19|
|FENTANYL CITRATE LOZENGE||Prior authorization for medical necessity is required. The limits are 4 lozenges per day.||P||06/23/03|
|FENTANYL TD®||The limits are 15 patches per 30 days.||P||03/03/15|
|FENTORA®||Prior authorization for medical necessity is required. Patients must have trial and failure of generic product. The limits are 4 tablets per day.||P||09/01/06|
|FETZIMA®||The limits are 1 capsule per day or 1 titration pack per 180 days.||P||01/01/14||04/01/16|
|FIORICET||The limits are 6 tablets per day.||P||04/01/13|