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|
|WELLBUTRIN SR®||The limits are 2 tablets per day.||P||08/06/08|
|WELLBUTRIN XL®||The limits are 1 tablet per day for Wellbutrin XL 150mg and 1 tablet per day for Wellbutrin XL 300mg.||P||07/15/04||10/01/16|
|WELLBUTRIN®||The limits for Wellbutrin 75mg are 2 tablets per day. The limits for Wellbutrin 100mg are 4 tablets per day.||P||08/06/08||10/01/16|
|WILATE||Prior authorization for medical necessity and dispensing may be required.||P||07/01/19|