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|
|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|
|CARIMUNE® NF||Predetermination for medical necessity is available.||M||01/01/15|
|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|
|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|
|CHANTIX®||Coverage provided for up to a 24-week (168 days) supply per calendar year.||P||08/01/06||04/01/12|
|CIALIS®||Prior authorization for medical necessity may be required. The limits for Cialis 10mg and 20mg tablets are 8 tablets per 30 days. The limits for Cialis 2.5mg and 5mg tablets are 30 tablets per 30 days. Patients must be at least 18 years of age.||P||01/01/04||02/08/10|
|CIMZIA®||Step Therapy and Quantity Limits apply when self-administered. Predetermination for medical necessity is available when physician-administered.||B||06/23/09||01/01/16|
|CINRYZE®||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|
|COCET PLUS®||The limits are 6 tablets per day.||P||01/01/11|
|COCET®||The limits are 6 tablets per day.||P||04/01/13|
|CODEINE||The limits are 180 tablets per 30 days.||P||01/01/13|