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|
|QBREXA||Prior authorization for medical necessity is required. The limits are 1 cloth per day.||P||04/01/19|
|QNASL CHILDREN®||The limits are 1 inhaler per month.||P||04/01/15|
|QNASL®||The limits are 1 bottle per 30 days.||P||07/01/12|
|QSYMIA||Prior authorization for medical necessity is required. The limits are 1 capsule per day for 3.75mg-23mg, 7.5mg-46mg, 11.25mg-69mg and 15mg-92mg.||P||07/01/19|
|Qtern||The limits are 1 tablet per day.||P|
|QUALAQUIN®||The limits are 42 capsules per 90 days, which allows for a single 7-day course of therapy.||P||05/01/07||01/01/12|
|QUDEXY XR||Prior authorization for medical necessity is required. The limits are 1 capsule per day for 25mg, 50mg, 100 mg, 150mg and 2 capsules per day for 200mg.||P||10/01/18|
|Quillichew||The limits are 1 tablet per day for the 10, 30 mg tablets, and 2 tablets per day for the 20mg tablets.||P|
|QUILLIVANT XR||The limits are 12 mL per day.||P||04/01/13||01/01/18|
|QVAR®||The limits are 1 canister per 30 days for 40mcg strength and 2 canisters per 30 days for 80mcg.||P||08/06/08||01/01/18|