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|
|COMETRIQ®||Prior authorization for medical necessity is required. The limits are 1 kit/28 days.||P||04/01/13|
|COMPLERA||The limits are 1 tablet per day.||P||07/01/12|
|COMPOUNDS||Prior authorization for medical necessity may be required.||B||01/01/00||01/01/16|
|CONCERTA®||The limits are 2 tablets per day.||P||11/01/02||04/01/11|
|CONZIP®||The limits are 30 capsules per 30 days.||P||01/01/12|
|COPAXONE®||The limits are 1 carton of 30 syringes per 30 days.||P||10/01/12|
|CORLANOR®||Prior Authorization for medical necessity may be required. Quantity limits are 2 tablets per day.||P||10/01/15|
|COSENTYX®||Cosentyx may be subject to step therapy requirements. Patients must have trial and failure of 2 preferred products. Preferred products are Humira, Enbrel, Stelara, and Simponi. Quantity limits apply based on package size.||P||04/01/15|
|COTELLIC||Prior authorization for medical necessity is required. The limits are 63 tablets per 30 days.||P||11/25/15||01/01/16|
|COZAAR®||Cozaar 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|
|CRESTOR®||Crestor may be subject to step therapy requirements. Patients must have trial and failure of generic statin (lovastatin, pravastatin, simvastatin).||P||01/01/11|
|CRIXIVAN||The limits are 9 capsules per day for 200 mg, and 6 capsules per day for 400 mg strengths.||P||07/01/12||10/01/15|
|CYMBALTA®||The limits are 2 capsules per day, except Cymbalta 60mg with a limit of 1 capsule per day.||P||09/01/04|
|DAKLINZA®||Prior authorization for medical necessity is required. Quantity limits may apply based on strength.||P||08/14/15|
|DANAZOL||Prior authorization for medical necessity is required.||P||04/01/12|