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|
|JAKAFI™||Prior authorization for medical necessity is required. The limits are 2 tablets per day.||P||04/01/12|
|JANUMET®||The limits are 2 tablets per day.||P||05/01/07|
|JANUMET® XR||The limits are 1 tablet per day, except 50 mg/1000 mg tablets which have a limit of 2 tablets per day.||P||07/01/12|
|JANUVIA®||The limits are 1 tablet per day.||P||11/01/06|
|JARDIANCE®||The limits are 1 tablet per day.||P||10/01/14|
|JENTADUETO XR||The limits are 2 tablets per day for 2.5 mg/1000 mg, and 1 tablet per day for 5 mg/1000 mg strengths.||P||10/01/16|
|JENTADUETO®||The limits are 2 tablets per day.||P||07/01/12|
|JIVI||Prior authorization for medical necessity and dispensing may be required.||P||07/01/19|
|JUBLIA®||Prior authorization for medical necessity is required. The limits are 4ml per 30 days.||P||07/01/16|
|Juluca||The limits are 1 tablet per day,||P||04/01/18|
|JUVISYNC||The limits are 30 tablets per 30 days, except for the 50-10 mg and 50-20 mg strengths with a limit of 60 tablets per 30 days.||P||04/01/12||07/01/14|
|JUXTAPID||Prior authorization for medical necessity is required. The limits are 1 capsule per day.||P||07/01/13|
|JYNARQUE||Prior authorization for medical necessity is required. The limits for 15 mg, 30 mg, 45 mg, 60 mg and 90 mg are 56 tablets (4 blister cards) every 28 days.||P||01/01/19||07/01/19|