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|
|Vanatol LQ||The limits are 90 mLs for 50 mg/325 mg/40 mg/15 mL solution per day.||P||04/01/18|
|VARUBI||The limits are 4 tablets per 30 days.||P||11/03/15||01/01/16|
|VECTIBIX®||Prior authorization for medical necessity is required.||M||01/01/15||04/01/16|
|VELCADE®||Prior authorization for medical necessity is required.||M||04/01/19|
|VELTIN®||Prior authorization for medical necessity may be required.||P||01/01/11|
|VENCLEXTA||A prior authorization for medical necessity may be required. The limits are 2 tablets per day for the 10mg tablets, 1 per day for the 50mg, 4 per day for the 100mg tablets. The limits are 1 pack (42 tablets) per 180 days for the starter pack.||P||07/01/16|
|VENLAFAXINE ER||The limits are 1 tablet per day,||P||11/12/08||04/01/18|
|VENTAVIS®||Prior authorization for medical necessity is required. The limits are 9 packages of 30 ampules/30 days.||P||07/01/15|
|VENTOLIN HFA||The limits are 2 inhalers per 30 days.||P||04/01/12|
|VERAMYST®||The limits are 1 box per 30 days.||P||07/01/07|
|VERSACLOZ™||Versacloz may be subject to step therapy requirements. Patients must have trial and failure of a generic atypical antipsychotic. The limits are 540 mls per 30 days.||P||07/01/16|
|VERZENIO||A prior authorization for medical necessity may be required. The limits are 2 tablets per day.||P||09/01/17|
|VIAGRA||Prior authorization for medical necessity may be required. 8* tablets per month. *Confirm group specific policies.||P||04/01/18|
|VIAGRA®||Prior authorization for medical necessity may be required. The limits are 8 tablets per 30 days. Patients must be at least 18 years of age.||P||07/01/98||10/18/02|
|VIBRAMYCIN®||Vibramycin capsules, suspension and syrup may be subject to step therapy requirements. Patients must have trial and failure of generic immediate release doxycycline AND generic immediate release minocycline.||P||04/01/13||01/01/15|