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|
|GABAPENTIN||The limits are 6 capsules per day for 100mg; 3 capsules per day for 300mg; 3 capsules per day for 400mg; 4 tablets per day for 600mg; 3 tablets per day for 800mg; 36mg per day for 250mg/5 ml solution||P||07/01/18|
|GALAFOLD||Prior authorization for medical necessity is required. The limits are 14 capsules per 28 days.||P||04/01/19|
|GAMIFANT™||Prior authorization for medical necessity is required.||M||11/20/18||07/01/19|
|GAMMAGARD® LIQUID||Prior authorization for medical necessity is required when self-administered or physician-administered.||B||10/01/14||04/01/16|
|GAMMAGARD® S/D||Prior authorization for medical necessity is required when self-administered or physician-administered.||B||01/01/15||04/01/16|
|GAMMAPLEX® LIQUID||Prior authorization for medical necessity is required.||M||04/01/16|
|GAMUNEX®-C||Prior authorization for medical necessity is required when self-administered or physician-administered.||B||01/01/12||04/01/16|
|GATTEX®||Prior authorization for medical necessity is required.||P||07/01/13|
|GAZYVA™||Prior authorization for medical necessity is required.||M||01/01/15||04/01/16|
|GEL-ONE®||Gel-One is not covered per medical policy. Refer to preferred products Synvisc or Synvisc-One.||M||05/01/15||04/01/16|
|GELSYN-3||Gelsyn-3 is not covered per medical policy. Refer to preferred products Synvisc or Synvisc-One.||M||05/01/15||04/01/16|
|GENOTROPIN®||Prior authorization for medical necessity is required. Use of the preferred growth hormone, Omnitrope, may be required.||P||10/01/11|
|GENVISC 850®||Genvisc 850 is not covered per medical policy. Refer to preferred products Synvisc or Synvisc-One.||M||04/01/16|
|GENVOYA||The limits are 30 tablets per 30 days.||P||11/10/15||01/01/16|
|GEODON||Geodon 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 20mg, 40mg, 60mg, and 80 mg capsules. The limits are 2 vials per day for the 20mg injection.||P||07/01/16|