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|
|AVONEX®||Avonex 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 one 30mg vial, syringe, or pen per week or 1 kit per 28 days.||P||01/01/12||01/01/15|
|AXERT®||Axert may be subject to step therapy requirements. Patients must have trial and failure of generic triptan (naratriptan, sumatriptan, rizatriptan). The limits are 12 tablets per 30 days.||P||11/01/05||07/01/15|
|AXIRON®||The limits are 180mL (2 bottles) per 30 days.||P||07/01/11||04/01/12|
|AZOR®||Azor may be subject to step therapy requirements. Patients must have a trial and failure of a generic ACE inhibitor or generic ARB.||P||01/01/11||10/01/15|
|BECONASE AQ®||The limits are 2 bottles per 30 days.||P||11/13/01|
|BELSOMRA®||The limits are 1 tablet per day.||P||04/01/15|
|BENICAR HCT®||Benicar 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|
|BENICAR®||Benicar 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|
|BENLYSTA®||Predetermination for medical necessity is available.||M||01/01/15||01/01/16|
|BERINERT®||Prior authorization for medical necessity is required when self-administered. Predetermination for medical necessity is available when physician-administered.||B||01/01/15||01/01/16|
|BETASERON®||The limits are 14 vial/syringe units per 28 days and 1 kit (14 prefilled syringes) per 28 days.||P||10/01/12||01/01/14|
|BETHKIS®||Prior authorization for medical necessity may be required. Must not be used concurrently with inhaled tobramycin or Cayston.||P||01/01/14|
|BINOSTO®||The limits are 4 tablets per 28 days.||P||01/01/13||07/01/13|
|BIO-T-GEL®||The limits are 2 packets per day.||P||10/01/12|
|BIVIGAM™||Predetermination for medical necessity is available.||M||01/01/15|