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
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
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
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
GAZYVA™ Prior authorization for medical necessity is required. M 01/01/15 04/01/16
GEL-ONE® Gel-One is not covered per medical policy. Refer to preferred products Synvisc or Synvisc-One. M 05/01/15 04/01/16
GENOTROPIN® Prior authorization for medical necessity is required. Use of the preferred growth hormone, Omnitrope, may be required. P 10/01/11
GENVISC 850® Genvisc 850 is not covered per medical policy. Refer to preferred products Synvisc or Synvisc-One. M 04/01/16
GENVOYA The limits are 30 tablets per 30 days. P 11/10/15 01/01/16
GILENYA® Gilenya may be subject to step therapy. Patients must have trial and failure of one of the five preferred products: Betaseron, Copaxone, Plegridy, Rebif or Tecfidera. The limits are 1 tablet per day. P 01/01/11 01/01/15
GILOTRIF® Prior authorization for medical necessity is required. The limits are 1 tablets per day. P 01/01/14
GLEEVEC® Prior authorization for medical necessity is required. The limits are 3 tablets per day for 100mg or 2 tablets per day for 400mg. P 05/01/01 07/01/11