GroupAccess > Drug Coverage Guidelines

You are not signed in.

myBlueCross for Members
Forgot Username?
Forgot Password?

New to GroupAccess?

 

Search by Drug Name

  

All A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Product Name Implementation Date Guideline
ABSTRAL® 04/01/11 Prior authorization for medical necessity is required. The limits are 4 tablets per day.
ACCOLATE® 02/01/05 The limits are 2 tablets per day.
ACETAMINOPHEN WITH CODEINE 03/23/04 The limits are 13 tablets per day for acetaminophen with codeine 300mg/15mg, 12 tablets per day for acetaminophen with codeine 300mg/30mg, and 6 tablets per day for acetaminophen with codeine 300mg/60mg.
ACIPHEX® 02/18/02 Aciphex may be subject to step therapy requirements. Patients must have trial and failure of generic lansoprazole, omeprazole, pantoprazole, or rabeprazole. The limits are 1 tablet per day for the 20mg tablets and 1 capsule per day for the 5mg and 10mg sprinkle.
ACTEMRA® 01/01/14 Actemra subcutaneous injection may be subject to step therapy requirements. Patients must have trial and failure of 2 preferred products. Preferred products are Humira, Enbrel, Stelara, and Simponi. The limits are 4 syringes per 28 daysa.
ACTICLATE® 10/01/14 Acticlate maybe subject to step therapy requirements. Patients must have trial and failure of generic immediate release doxycycline AND generic immediate release minocycline.
ACTIQ® 06/23/03 Prior authorization for medical necessity is required. The limits are 4 lozenges per day.
ACTONEL® 01/01/00 The limits are 1 tablet per day for Actonel 5mg and 30mg, 1 tablet per week for Actonel 35mg, and 1 tablet per 30 days for Actonel 150mg.
ACTOPLUS MET XR® 01/01/11 The limits are 2 tablets per day for Actoplus Met XR 15/1000mg and 1 tablet per day for Actoplus Met XT 30/1000mg.
ACTOPLUS MET® 08/06/08 The limits are 3 tablets per day.
ACTOS® 07/01/10 The limits are 1 tablet per day.
ADAPALENE 04/01/01 Prior authorization for medical necessity may be required.
ADCIRCA® 04/01/15 Prior authorization for medical necessity is required.
ADDERALL XR® 11/13/02 The limits are 2 tablets per day.
ADEMPAS® 04/01/15 Prior authorization for medical necessity is required.

1 2 3 4 5