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|
|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™||Prior authorization for medical necessity is required.||M||01/01/15||04/01/16|
|BONIVA®||The limits are 1 tablet per 30 days for Boniva 150mg.||P||06/01/05||07/01/13|
|BOSULIF®||Prior authorization for medical necessity is required. The limits are 1 tablet per day.||P||11/15/12|
|BOTOX®||Prior authorization for medical necessity is required.||M||01/01/15||04/01/16|
|BREO ELLIPTA®||The limits are 1 inhaler per month.||P||01/01/14||10/01/15|
|BUNAVIL®||Prior authorization for medical necessity is required. The 2.1mg film has a quantity limit of 3 per day. The 4.2mg and 6.3mg film has a limit of 2 per day.||P||01/01/15||04/01/16|
|BUPHENYL®||Prior authorization for medical necessity is required.||P||07/01/13|
|BUPRENORPHINE||Prior authorization for medical necessity is required. The limits are 5 tablets per 90 days.||P||04/01/16|
|BUTALBITAL COMPOUND||The limits are 6 tablets per day.||P||04/01/13|
|BUTALBITAL/ACETAMINOPHEN||The limits are 6 tablets per day.||P||04/01/13|
|BUTRANS®||The limits are 4 transdermal systems per 30 days.||P||04/01/11|
|BYDUREON®||Bydureon may be subject to step therapy requirements. Patients must have trial and failure of one or more of the following antidiabetic agents: metformin, sulfonylurea, combinations of metformin or sulfonylureas, or basal insulin (Lantus or Levemir). The limits are 4 vials or pens per 28 days.||P||04/01/12||10/01/14|