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|
|MACUGEN®||Prior authorization for medical necessity is required.||M||01/01/15||04/01/16|
|MAGNACET®||The limits are 10 tablets per day for Magnacet 5/400mg. The limits are 8 tablets per day for Magnacet 7.5/400mg and 6 tablets per day for Magnacet 10/400mg.||P||09/01/04||04/01/13|
|MAKENA®||Prior authorization for medical necessity is required.||M||01/01/15||04/01/16|
|MAPROTILINE||The limits are 3 tablets per day.||P||10/01/16|
|MATULANE||Prior authorization for medical necessity is required.||P||04/01/18|
|MAVYRET||Prior authorization for medical necessity is required.||P||10/14/14||01/22/15|
|MAXAIR||The limits are 1 inhaler per 30 days.||P||04/01/12|
|MAXALT®||Maxalt may be subject to step therapy requirements. Patients must have trial and failure of a generic triptan (naratriptan, sumatriptan, rizatriptan). The limits are 18 tablets per 30 days.||P||11/01/05||07/01/15|
|MAXIDONE®||The limits are 5 tablets per day.||P||09/01/03|
|MEKINIST®||Prior authorization for medical necessity is required. The limits are 3 tablets per day for 0.5 mg strength and 1 tablet per for all other strengths.||P||01/01/14|
|MENOSTAR||The limits are 4 patches(1mg) per 28 days.||P||04/01/19|
|MEPSEVII||Prior authorization for medical necessity is required.||M||11/15/17||05/01/18|
|METADATE||The limits are 3 tablets per day for the 20mg tablets.|
|METADATE CD®||The limits are 1 capsule per day.||P||01/01/05||10/01/16|
|METFORMIN SR MODIFIED RELEASE||Metformin SR modified release may be subject to step therapy requirements.||P||07/01/16|