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|
|ZALTRAP®||Prior authorization for medical necessity is required.||M||01/01/15||04/01/16|
|ZAMICET®||The limits are 90mL per day.||P||05/15/09|
|ZARXIO®||Prior authorization for medical necessity is required when physician-administered.||M||01/01/16||04/01/16|
|ZAVESCA||Prior authorization for medical necessity is required. The limits are 3 capsules per day.||P||10/01/17|
|ZECUITY||Zecuity may be subject to step therapy requirements. Patients must have trial and failure of a generic triptan (naratriptan, sumatriptan, rizatriptan). The limits are 12 transdermal systems per 30 days.||P||07/01/13||07/01/15|
|Zegerid||The limit is 1 capsule or packet per day.||P||04/01/18|
|ZEGERID®||Zegerid is not included in our formularies and is non-covered.||P||08/01/06||04/01/14|
|ZEJULA||Prior authorization for medical necessity is required. The limits are 3 capsules per day.||P||09/01/17|
|ZELBORAF®||Prior authorization for medical necessity is required. The limits are 8 tablets per day.||P||01/01/12|
|ZEMBRACE SYMTOUCH||Zembrace SymTouch may be subject to step therapy requirements. Patients must have trial and failure of a generic triptan (naratriptan, sumatriptan, rizatriptan). The limits are 24 pens per 30 days.||P||07/01/17|
|ZENZEDI||The limits are 3 tablets per day, except for Zenzedi 30mg which has a limit of 2 tablets per day.||P||10/01/16|
|ZEPATIER||Prior authorization for medical necessity is required.||P||07/01/16|
|ZERIT||The limits are 2 capsules or 80 mL per day.||P||07/01/12|
|ZerLor||The limits are 5 tablets per 712.8mg/60mg/32mg tablets per day.||P||04/01/18|
|ZETIA||Zetia may be subject to step therapy requirements.||P||10/01/17|