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|
|RADICAVA||Prior authorization for medical necessity is required.||M||05/05/17||09/01/17|
|RASUVO®||Rasuvo may be subject to step therapy. Patients must have trial and failure of a generic injectable methotrexate.||P||07/01/15|
|RAVICTI||Prior authorization for medical necessity is required.||P||07/01/13|
|REBIF®||The limits are 3 syringes per week or 1 titration kit per 180 days.||P||10/01/12||04/01/16|
|REBINYN||Prior authorization for medical necessity and dispensing may be required.||P||07/01/19|
|RECOMBINATE||Prior authorization for medical necessity and dispensing may be required.||P||07/01/19|
|REGIMEX||Prior authorization for medical necessity is required. The limits are 25 mg 3 tablets per day.||P||07/01/19|
|RELENZA®||The limits are 40 blisters per 120 days.||P||12/03/01||10/01/16|
|RELISTOR®||Prior authorization for medical necessity is required.||P||08/06/08||10/01/11|
|RELPAX®||Relpax may be subject to step therapy. Patients must have trial and failure of a generic triptan (naratriptan, sumatriptan, rizatriptan). The limits are 12 tablets per 30 days.||P||11/01/05||07/01/15|
|REMERON||The limits are 1 tablet per day.||P||10/01/16|
|REMERON SOLTAB||The limits are 1 tablet per day.||P||10/01/16|
|REMICADE®||Prior authorization for medical necessity is required.||M||01/01/15||04/01/16|
|RENFLEXIS||Prior authorization for medical necessity is required.||M||04/21/17||10/01/17|
|REPATHA||Prior authorization for medical necessity may be required. The quantity limits are 2 syringes per 28 days except Repatha 420mg which has a limit of 1 syringe per 30 days.||P||08/26/15||10/01/16|