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
SAIZEN® 10/01/11 Prior authorization for medical necessity is required. Use of the preferred growth hormone, Omnitrope, may be required.
SAIZEN® CLICK-EASY 01/01/13 Prior authorization for medical necessity is required. Use of the preferred growth hormone, Omnitrope, may be required.
SANCUSO® 11/12/08 Sancuso may be subject to step therapy requirements. Patients must have trial and failure of generic ondansetron or granisetron. The quantity limits are 1 patch per month.
SAVAYSA® 04/01/15 The limits are 30 tablets per month.
SEEBRI NEOHALER 11/19/15 The limits are 60 capsules per 30 days.
SELZENTRY 07/01/12 The limits are 2 tablets per day for 150 mg and 2 tablets per day for 300 mg strengths.
SEREVENT® DISKUS® 08/06/08 The limits are 2 blisters per day.
SEROSTIM® 10/01/11 Prior authorization for medical necessity is required. Use of the preferred growth hormone, Omnitrope, may be required.
SIGNIFOR® 07/01/13 Prior authorization for medical necessity is required. Quantity limits are 2ml/day.
SILENOR 07/01/11 The limits are 1 tablet per day.
SIMCOR® 01/01/11 Simcor may be subject to step therapy requirements. Patients must have trial and failure of generic statin (lovastatin, pravastatin, simvastatin).
SIMPONI ARIA 01/01/15 Predetermination for medical necessity is available.
SIMPONI® 05/06/09 Step Therapy and Quantity Limits apply when self-administered.
SINGULAIR® 01/01/00 The limits are 1 tablet or packet per day.
SOLARAZE 01/01/16 Prior authorization for medical necessity is required. Limited to one 100 gram tube per 30 days.

1 2 3