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
AFINITOR® DISPERZ Prior authorization for medical necessity is required. The limits are 2 tablets per day, except the 3 mg tablets which have a limit of 3 tablets per day. P 07/01/13
AFINITOR® DISPERZ Prior authorization for medical necessity is required. The limits are 2 tablets per day, except the 3 mg tablets which have a limit of 3 tablets per day. P 07/01/13
AFREZZA® Prior authorization for medical necessity is required. The limits are 2,520 cartridges per 30 days for the 4 unit pack, 1,530 cartridges per 30 days for the 30 x 4 unit mix pack, and 1,890 cartridges per 30 days for the 60 x 4 unit mix pack. P 01/22/15 06/28/15
AFREZZA® Prior authorization for medical necessity is required. The limits are 2,520 cartridges per 30 days for the 4 unit pack, 1,530 cartridges per 30 days for the 30 x 4 unit mix pack, and 1,890 cartridges per 30 days for the 60 x 4 unit mix pack. P 01/22/15 06/28/15
AKYNZEO® The limits are 2 capsules per 30 days. P 01/01/15
AKYNZEO® The limits are 2 capsules per 30 days. P 01/01/15
ALECENSA® Prior authorization for medical necessity is required. The quantity limits are 8 capsules per day. P 04/01/16
ALECENSA® Prior authorization for medical necessity is required. The quantity limits are 8 capsules per day. P 04/01/16
ALENDRONATE The limits are 1 tablet per day for 40mg tablets and 300mls per 28 days for the oral solution. P 07/01/13 01/01/14
ALENDRONATE The limits are 1 tablet per day for 40mg tablets and 300mls per 28 days for the oral solution. P 07/01/13 01/01/14
ALIMTA® Prior authorization for medical necessity is required. M 05/01/16
ALODOX® Alodox may be subject to step therapy requirements. Patients must have trial and failure of generic immediate release doxycycline AND generic immediate release minocycline. P 04/01/13 01/01/15
ALODOX® Alodox may be subject to step therapy requirements. Patients must have trial and failure of generic immediate release doxycycline AND generic immediate release minocycline. P 04/01/13 01/01/15
ALOXI® Prior authorization for medical necessity is required. M 01/01/15 04/01/16
ALOXI® Prior authorization for medical necessity is required. M 01/01/15 04/01/16