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
GAMASTAN™ S/D Prior authorization for medical necessity is required. M 04/01/16
GAMASTAN™ S/D Prior authorization for medical necessity is required. M 04/01/16
GAMMAGARD® LIQUID Prior authorization for medical necessity is required when self-administered or physician-administered. B 10/01/14 04/01/16
GAMMAGARD® LIQUID Prior authorization for medical necessity is required when self-administered or physician-administered. B 10/01/14 04/01/16
GAMMAGARD® S/D Prior authorization for medical necessity is required when self-administered or physician-administered. B 01/01/15 04/01/16
GAMMAGARD® S/D Prior authorization for medical necessity is required when self-administered or physician-administered. B 01/01/15 04/01/16
GAMMAKED™ Prior authorization for medical necessity is required when self-administered or physician-administered. B 10/01/14 04/01/16
GAMMAKED™ Prior authorization for medical necessity is required when self-administered or physician-administered. B 10/01/14 04/01/16
GAMMAPLEX® LIQUID Prior authorization for medical necessity is required. M 04/01/16
GAMMAPLEX® LIQUID Prior authorization for medical necessity is required. M 04/01/16
GAMUNEX®-C Prior authorization for medical necessity is required when self-administered or physician-administered. B 01/01/12 04/01/16
GAMUNEX®-C Prior authorization for medical necessity is required when self-administered or physician-administered. B 01/01/12 04/01/16
GATTEX® Prior authorization for medical necessity is required. P 07/01/13
GATTEX® Prior authorization for medical necessity is required. P 07/01/13
GAZYVA™ Prior authorization for medical necessity is required. M 01/01/15 04/01/16