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|
|FABIOR||Prior authorization for medical necessity may be required.||P||07/01/13|
|FARXIGA®||The limits are 1 tablet per day.||P||04/01/14|
|FARYDAK®||The limits are 6 capsules per 21 days.||P||07/01/15|
|FENTANYL CITRATE LOZENGE||Prior authorization for medical necessity is required. The limits are 4 lozenges per day. Patients must be at least 16 years of age.||P||06/23/03|
|FENTANYL TD®||The limits are 15 patches per 30 days.||P||03/03/15|
|FENTORA®||Prior authorization for medical necessity is required. Patients must have trial and failure of generic product. The limits are 4 tablets per day.||P||09/01/06|
|FETZIMA®||The limits are 1 capsule per day or 1 titration pack per 28 days.||P||01/01/14|
|FIORICET||The limits are 6 tablets per day.||P||04/01/13|
|FIORICET WITH CODEINE||The limits are 6 tablets per day.||P||04/01/13|
|FIORINAL||The limits are 6 capsules per day.||P||04/01/13|
|FIORINAL WITH CODEINE||The limits are 6 capsules per day.||P||04/01/13|
|FIRAZYR®||Prior authorization for medical necessity is required when self-administered. Predetermination for medical necessity is available when physician-administered.||B||04/01/12||01/01/16|
|FIRST-LANSOPRAZOLE||FIRST-Lansoprazole may be subject to step therapy requirements. Patients must have trial and failure of generic lansoprazole, omeprazole, pantoprazole, or rabeprazole. The limits are 10 mL per day.||P||07/01/12||04/01/14|
|FIRST-OMEPRAZOLE||FIRST-Omeprazole may be subject to step therapy requirements. Patients must have trial and failure of generic lansoprazole, omeprazole, pantoprazole, or rabeprazole. The limits are 20 mL per day.||P||07/01/12||04/01/14|
|FIRST-TESTOSTERONE||The limits are 60 grams per 30 days.||P||04/01/12|