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
LANSOPRAZOLE The limits are 1 capsule or solutab per day. P 01/01/00
LARTRUVO Prior authorization for medical necessity is required. M 04/01/18
LATUDA® Latuda may be subject to step therapy requirements. Patients must have trial and failure of a generic atypical antipsychotic. The limits are 1 tablet per day for the 20mg, 40mg, 60 mg, and 120mg tablets. The limits are 2 tablets per day for the 80mg tablets. P 07/01/16
LAZANDA® Prior authorization for medical necessity is required. Patients must have trial and failure of generic product. The limits are 1 bottle per day. P 01/01/12 10/01/15
LEMTRADA® Prior authorization for medical necessity is required. Lemtrada is not eligible for physician buy and bill and must be obtained by an in-network medical specialty pharmacy. M 01/01/15 08/01/16
LENVIMA® Prior authorization for medical necessity is required. Quantity limits are in place and vary based on strength. P 04/01/15
LESCOL XL® Lescol XL may be subject to step therapy requirements. Patients must have trial and failure of generic statin (lovastatin, pravastatin, simvastatin). P 01/01/11
LESCOL® Lescol may be subject to step therapy requirements. Patients must have trial and failure of generic statin (lovastatin, pravastatin, simvastatin). P 01/01/11
LETAIRIS® Prior authorization for medical necessity is required. The limits are 1 tablet per day. P 04/01/15
LEVITRA Prior authorization for medical necessity may be required. 8* tablets per month. *Confirm group specific policies. P 04/01/18
LEVITRA® Prior authorization for medical necessity may be required. The limits are 30 tablets for 2.5mg, and 5mg tablets per month; 6 tablets for the 10 mg and 20mg tablets per month. Patients must be at least 18 years of age. P 09/01/03 01/01/19
LEVORPHANOL The limits are 4 tablets per day. P 01/01/13
LEXAPRO The limits are 1 tablet per day for the 5 mg, 10 mg, and 20 mg tablets. The limits are 600 mLs per 30 days for the oral solution. P 10/01/16
LEXIVA The limits are 4 tablets per 60 mL per day. P 07/01/12
LEXXEL® Lexxel may be subject to step therapy requirements. P 01/01/11