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|
|ATRALIN®||Prior authorization for medical necessity may be required.||P||04/01/01|
|ATRIPLA||The limits are 1 tablet per day.||P||07/01/12|
|ATROVENT HFA||The limits are 2 inhalers per 30 days.||P||04/01/12|
|ATROVENT NASAL INHALER||The limits are 60 mL per 30 days for 21 mcg/spray and 45 mL per 30 days for 42 mcg/spray.||P||07/01/13|
|AUBAGIO®||Aubagio may be subject to step therapy. Patients must have trial and failure of one of the five preferred products: Betaseron, Copaxone, Plegridy, Rebif, or Tecfidera. The limits are 1 tablet per day.||P||01/01/13||01/01/15|
|AVALIDE®||Avalide 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|
|AVANDAMET®||The limits are 2 tablets per day.||P||08/06/08||04/01/12|
|AVANDARYL®||The limits are 1 tablet per day.||P||07/01/10||04/01/12|
|AVANDIA®||Avandia 2mg and 4mg has a limit of 2 tablets per day. Avandia 8mg has a limit of 1 tablet per day.||P||07/01/10||04/01/12|
|AVAPRO®||Avapro may be subject to step therapy requirements. Patients must have trial and failure of both of a generic ACE inhibitor or generic ARB.||P||01/01/11||10/01/15|
|AVASTIN®||Predetermination for medical necessity is available||M||01/01/15|
|AVEED™||Predetermination for medical necessity is available||M||01/01/15|
|AVIDOXY® DK||Avidoxy DK 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|
|AVINZA®||The limits are 1 capsule per day.||P||05/15/09|
|AVITA®||Prior authorization for medical necessity may be required.||P||04/01/01|