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|
|NAGLAZYME||Prior authorization for medical necessity is required.||M||07/01/18|
|NALOXONE||The limits 2 syringes per 365 days.||P||04/01/16|
|NARCAN NASAL SPRAY||The limits are 1 package (2 nasal sprays) per 365 days.||P||04/01/16|
|NASACORT AQ®||The limits are 1 box per 30 days.||P||04/01/04|
|NASAREL®||The limits are 3 boxes per 30 days.||P||08/06/08||04/01/11|
|NASONEX®||The limits are 2 bottles per 30 days.||P||02/22/05||07/01/16|
|Natesto||Prior authorization for medical necessity is required. Use of the preferred topical androgen products Androderm and Androgel may be required. The limits are 1.1 gram/day (180 pumps/30 days) for the 5.5 mg/actuation, 11 gm pump (60 actuations/pump).||P||04/01/18|
|NATESTO®||Prior authorization for medical necessity is required. Use of the preferred topical androgen products Androderm and Androgel may be required. The limits are 3 pumps per 30 days.||P||07/01/15||07/01/16|
|NATPARA®||Prior Authorization for medical necessity is required. The limits are 1 package of 2 cartridges per 28 days.||P||10/01/15|
|NERLYNX||Prior authorization for medical necessity is required. The limits are 6 tablets per day.||P||09/01/17|
|NESINA||The limits are 1 tablet per day.||P||04/01/13|
|NEULASTA||Prior authorization for medical necessity is required. (Physican-administered)||M||05/01/19|
|NEULASTA ONPRO||Prior authorization for medical necessity is required. (Physican-administered)||M||05/01/19|
|NEVIRAPINE||The limits are 40 mL per day.||P||07/01/12|
|NEXAVAR®||Prior authorization for medical necessity is required. The limits are 4 tablets per day.||P||01/01/06|