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|
|PALONOSETRON||Prior authorization for medical necessity is required.||M||07/01/18|
|PALYNZIQ||Prior authorization for medical necessity is required.||P||10/01/18|
|PANLOR SS||The limits are 5 tablets per 712.8mg/60mg/32mg tablets per day.||P||10/01/12|
|PANTOPRAZOLE||The limits are 1 tablet per day.||P||07/01/10||04/01/11|
|PANZYGA®||Prior authorization for medical necessity is required.||M||08/02/18||01/01/19|
|PATANASE®||The limits are 1 box per 30 days.||P||08/06/08|
|PAXIL||The limits are 1 tablet per day except for Paxil 30 mg which has a limit of 2 tablets per day. The limits are 900 mL per 30 days for 10 mg/5 mL suspension.||P||10/01/16|
|PAXIL CR||The limits are 2 tablets per day except for Paxil CR 12.5 mg which has a limit of 1 tablet per day.||P||10/01/16|
|PEGASYS®||Prior authorization for medical necessity is required.||P||06/01/06||01/01/11|
|PEGINTRON||Prior authorization for medical necessity is required.||P||06/01/06||01/01/11|
|PENLAC||Prior authorization for medical necessity is required. The limits are 6.6 ml per 30 days.||P||07/01/06|
|PERCOCET®||The limits are 12 tablets for the 2.5 mg and 5 mg oxycodone tablets, 8 tablets for the 7.5 mg tablets, and 6 tablets for the 10 mg tablets per day.||P||09/01/04|
|PERCODAN®||The limits are 12 tablets per day.||P||03/29/04|
|PERJETA®||Prior authorization for medical necessity is required.||M||01/01/15||04/01/16|
|PEXEVA||The limits are 1 tablet per day except for Pexeva 30 mg which has a limit of 2 tablets per day.||P||10/01/16|