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
KADCYLA® Prior authorization for medical necessity is required. M 01/01/15 04/01/16
KADIAN® The limits are 2 capsules per day. P 05/15/09
KALBITOR® Prior authorization for medical necessity is required when self-administered or physician-administered. Quantity Limits may apply. B 01/01/15 04/01/16
KALETRA The limits are 6 tablets per day for 100 mg/25 mg, 4 tablets per day for 200 mg/50 mg, and 480 mL per 30 days for 80 mg/20 mg per mL oral solution. P 07/01/12 10/01/16
KALYDECO® Prior authorization for medical necessity is required. The limits are 2 tablets or 2 packets per day. P 07/01/12 07/01/15
KANUMA Prior authorization for medical necessity is required. M 07/01/18
KAPVAY The limits are 2 tablets per day except for Kapvay 0.1 mg which has a limit of 4 tablets per day. P 10/01/16
KAZANO The limits are 2 tablets per day. P 04/01/13
KERYDIN® Prior authorization for medical necessity is required. The limits are 4 ml per 30 days. P 07/01/16
KEVEYIS® Prior authorization for medical necessity is required. The quantity limits are 4 tablets per day. P 04/01/16
KEVZARA Prior authorization for medical necessity is required. The limits are 2 syringes per 28 days. P 01/01/18
KEYTRUDA® Prior authorization for medical necessity is required. M 01/01/15 04/01/16
KHEDEZLA® The limits are 30 tablets per 30 days. P 01/01/14
KINERET® Prior authorization for medical necessity is required. The limits are 1 syringe per day. P 07/17/02 01/01/18
KISQALI Prior authorization for medical necessity is required. The limits are 63 tablets per 28 days. P 09/01/17