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 or exclusions established by Blue Cross and Blue Shield of Alabama. The following guidelines are meant to help members understand the requirements related to their drug coverage. These drugs may require a doctor’s request for preapproval or prior authorization.
Please note: Some employer groups may have specific drug coverage requirements for their employees that are not included in the criteria below.
*Coverage Benefit - (P) Pharmacy Benefit, (M) Medical Benefit, (B) Both
Search by Drug Name
|Product Name||Guideline||*Coverage Benefit||Implementation Date||Change Date|
|ALOXI®||Prior authorization for medical necessity is required.||M||01/01/15||04/01/16|
|ALSUMA®||Alsuma may be subject to step therapy. Patients must have trial and failure of generic triptan (naratriptan, sumatriptan,rizatriptan). The limits are 12 doses per 30 days.||P||04/01/11||07/01/15|
|ALTOPREV®||Altoprev may be subject to step therapy requirements. Patients must have trial and failure of generic statin (lovastatin, pravastatin, simvastatin).||P||01/01/11|
|ALVESCO®||The limits are 1 box per 30 days for 80mcg strength and 2 boxes per 30 days for 160mcg strength.||P||08/06/08||04/01/11|
|AMBIEN CR®||The limits are 1 tablet per day.||P||10/01/05||07/01/13|
|AMBIEN®||The limits are 1 tablet per day.||P||02/25/02||07/01/13|
|AMERGE®||Amerge may be subject to step therapy. Patients must have trial and failure of a generic triptan (naratriptan, sumatriptan, rizatriptan). The limits are 18 tablets per 30 days.||P||11/01/05||07/01/15|
|AMITIZA®||Prior authorization for medical necessity is required.||P||09/01/06||10/01/11|
|AMPYRA®||Prior authorization for medical necessity is required. The limits are 2 tablets per day.||P||06/01/10|
|AMTURNIDE®||Amturnide may be subject to step therapy requirements. Patients must have trial and failure of a generic ACE inhibitor or generic ARB.||P||04/01/11||10/01/15|
|ANADROL®-50||Prior authorization for medical necessity is required.||P||07/20/09|
|ANDRODERM®||The limits are 1 patch per day.||P||07/20/09||04/01/14|
|ANDROGEL®||The limits are two cartons (60 packets) of 2.5 gram or 5 gram unit-dose packets per 30 days. The Androgel Pump has a limit of 4 pumps (300 grams) per 30 days. Androgel 1.62% has a limit of 2 bottles (150 grams), 30 1.25 gm packets, or 60 2.5 gm packets per 30 days.||P||06/15/04||01/01/13|
|ANDROID®||Prior authorization for medical necessity is required.||P||04/01/12|
|ANDROXY®||Prior authorization for medical necessity is required.||P||04/01/12|