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
SAIZEN® Prior authorization for medical necessity is required. Use of the preferred growth hormone, Omnitrope, may be required. P 10/01/11
SAIZEN® CLICK-EASY Prior authorization for medical necessity is required. Use of the preferred growth hormone, Omnitrope, may be required. P 01/01/13
SANCUSO® Sancuso may be subject to step therapy requirements. Patients must have trial and failure of generic ondansetron or granisetron. The quantity limits are 2 patches per 30 days. P 11/12/08 04/01/18
SAPHRIS® Saphris may be subject to step therapy requirements. Patients must have trial and failure of a generic atypical antipsychotic. The limits are 2 tablets per day. P 07/01/16
SAVAYSA® The limits are 30 tablets per month. P 04/01/15
SAVELLA The limits are 2 capsules per day for the 12.5 mg, 25 mg, 50 mg, and 100 mg tablets. The limit is 1 kit per 180 days for the titration pack. P 07/01/16
SAXENDA Prior authorization for medical necessity is required. The limits are 0.5 mL per day. P 07/01/19
SEEBRI NEOHALER The limits are 60 capsules per 30 days. P 11/19/15 01/01/16
Segluromet The limits are 2 tablets per day with the exception of the 2.5/500 mg tablets of 4 tablets per day. P 04/01/18
SELZENTRY The limits are 8 tablets per day for 25mg, 2 tablets per day for 75mg, 150 mg and 4 tablets per day for 300 mg strengths, and 1840mLs per 30 days. P 07/01/12 10/01/16
SEREVENT® DISKUS® The limits are 2 blisters per day. P 08/06/08
SEROQUEL XR® Seroquel XR may be subject to step therapy requirements. Patients must have trial and failure of a generic atypical antipsychotic. The limits are 2 tablets per day for the 50mg, 300mg, and 400 mg tablets. The limits are 1 tablet per day for the 150mg and 200mg tablets. P 07/01/16
SEROQUEL® Seroquel may be subject to step therapy requirements. Patients must have trial and failure of a generic atypical antipsychotic. The limits are 3 tablets per day for the 25mg, 50mg, 100mg, and 200 mg tablets. The limits are 2 tablets per day for the 300mg and 400mg tablets. P 07/01/16
SEROSTIM® Prior authorization for medical necessity is required. Use of the preferred growth hormone, Omnitrope, may be required. P 10/01/11
Signifor Prior authorization for medical necessity is required. P 07/01/13 04/01/18