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|
|EDARBI®||Edarbi may be subject to step therapy requirements. Patients must have trial and failure of a generic ACE inhibitor or generic ARB.||P||04/01/11||10/01/15|
|EDARBYCLOR®||Edarbyclor may be subject to step therapy requirements. Patients must have trial and failure of a generic ACE inhibitor or generic ARB.||P||07/01/12||10/01/15|
|EDEX®||Prior authorization for medical necessity may be required. Patients must be at least 18 years of age.||P||07/01/10|
|EDLUAR®||The limits are 1 tablet per day.||P||07/06/09||07/01/13|
|EDURANT||The limits are 1 tablet per day.||P||07/01/12|
|EFFEXOR XR®||The limits are 1 capsule per day, except Effexor XR 75mg which has a limit of 3 capsules per day.||P||07/01/05||02/13/08|
|ELIQUIS||The limits are 2 tablets per day for Eliquis 2.5mg and 4 tablets per day for Eliqus 5 mg.||P||07/01/13||10/01/14|
|EMBEDA®||The limits are 2 capsules per day.||P||09/09/09|
|EMEND®||The limits are 4 capsules per 30 days for Emend 80mg, 2 capsules per 30 days for Emend 125mg, and 2 packs (6 capsules) per 30 days for Emend 125mg/80mg packs.||P||11/12/08||04/01/12|
|EMTRIVA||The limits are 1 capsule or 24 mL per day.||P||07/01/12|
|ENBREL®||Enbrel may be subject to step therapy requirements. Patients must have trial and failure of a first-line DMARD. The limits are 8 doses of Enbrel 25mg or 4 doses of Enbrel 50mg per 28 days.||P||05/17/99||01/01/14|
|ENTRESTO®||Prior authorization for medical necessity may be required. The quantity limits are 2 tablets per day.||P||07/08/15|
|ENTYVIO®||Predetermination for medical necessity is available.||M||01/01/15|
|EPIDUO®||Prior authorization for medical necessity may be required.||P||01/01/11|