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|
|APLENZIN®||The limits are 1 tablet per day.||P||08/06/08|
|APTENSIO XR®||The limits are 1 tablet per day.||P||07/01/15|
|APTIVUS||The limits are 4 capsules or 13 mL per day.||P||07/01/12|
|ARCALYST||Prior authorization for medical necessity is required. Patients must be at least 12 years of age. The limits are four 220 mg vial per 28 days.||P||12/18/08||10/01/15|
|ARCAPTA®||The limits are 30 capsules per 30 days.||P||01/01/12|
|ARIXTRA®||The limits are 30 syringes per 90 days.||P||07/01/10||04/01/12|
|ARNUITY ELLIPTA®||The limits are 30 blisters per month.||P||04/01/15|
|ARZERRA®||Predetermination for medical necessity is available||M||01/01/15|
|ASMANEX HFA®||The limits are 1 inhaler per month.||P||04/01/15|
|ASMANEX®||The limits for Asmanex Twisthaler 110mcg are 30 inhalation units per 30 days and for Asmanex Twisthaler 220mcg are 120 inhalation units per 30 days.||P||01/26/06||04/22/08|
|ASTELIN||The limits are 60 mL per 30 days.||P||07/01/13|
|ASTEPRO||The limits are 60 mL per 30 days.||P||07/01/13|
|ATACAND HCT®||Atacand HCT may be subject to step therapy requirements. Patients must have trial and failure of a generic ACE inhibitor or generic ARB.||P||01/01/11||10/01/15|
|ATACAND®||Atacand may be subject to step therapy requirements. Patients must have trial and failure a generic ACE inhibitor or generic ARB.||P||01/01/11||10/01/15|
|ATELVIA®||The limits are 4 tablets per 30 days.||P||04/01/11||07/01/13|