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
CADUET® Only 1 statin covered per month. P 01/01/00
CADUET® Only 1 statin covered per month. P 01/01/00
CAPITAL® AND CODEINE The limits are 2700mL per 30 days. P 04/01/11
CAPITAL® AND CODEINE The limits are 2700mL per 30 days. P 04/01/11
CAPRELSA® Prior authorization for medical necessity is required. The limits are 2 tablets per day for the 100mg tablets and 1 tablet per day for the 300mg tablets. P 01/01/12
CAPRELSA® Prior authorization for medical necessity is required. The limits are 2 tablets per day for the 100mg tablets and 1 tablet per day for the 300mg tablets. P 01/01/12
CARIMUNE® NF Prior authorization for medical necessity is required. M 01/01/15 04/01/16
CARIMUNE® NF Prior authorization for medical necessity is required. M 01/01/15 04/01/16
CAVERJECT® Prior authorization for medical necessity may be required. Patients must be at least 18 years of age. P 07/01/10
CAVERJECT® Prior authorization for medical necessity may be required. Patients must be at least 18 years of age. P 07/01/10
CAYSTON® Prior authorization for medical necessity may be required. Must not be used concurrently with inhaled tobramycin or Bethkis. P 04/01/12 04/01/13
CAYSTON® Prior authorization for medical necessity may be required. Must not be used concurrently with inhaled tobramycin or Bethkis. P 04/01/12 04/01/13
CELEBREX® The limits are 2 capsules per day, except Celebrex 400mg which has a limit of 1 capsule per day. P 01/01/00 01/01/12
CELEBREX® The limits are 2 capsules per day, except Celebrex 400mg which has a limit of 1 capsule per day. P 01/01/00 01/01/12
CESAMET The limits are 42 capsules per 30 days. P 04/01/12