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|
|H.P. ACTHAR GEL®||Prior authorization for medical necessity is required when self-administered or physician-administered.||B||04/01/12||04/01/16|
|HARVONI®||Prior authorization for medical necessity is required.||P||10/14/14||01/22/15|
|HERCEPTIN®||Prior authorization for medical necessity is required.||M||01/01/15||04/01/16|
|HETLIOZ®||Prior authorization for medical necessity is required.||P||10/01/14|
|HEXALEN®||Prior authorization for medical necessity is required.||P||01/01/12|
|HIZENTRA™||Prior authorization for medical necessity is required when self-administered or physician-administered.||B||04/14/10||04/01/16|
|HORIZANT®||The limits are 60 tablets per 30 days.||P||01/01/12||07/01/13|
|HUMALOG®||Humalog may be subject to prior authorization. Patients must have trial and failure of Novolog.||P||01/01/15|
|HUMATROPE®||Prior authorization for medical necessity is required. Use of the preferred growth hormone, Omnitrope, may be required.||P||10/01/11|
|HUMIRA®||Humira may be subject to step therapy requirements. Patients must have trial and failure of a first-line DMARD. The limits are 2 doses per 28 days. One starter kit for Crohn's disease or Psoriasis will be covered per 180 days.||P||01/17/03||10/01/12|
|HUMULIN®||Humulin may be subject to prior authorization. Patients must have trial and failure of Novolin.||P||01/01/15|
|HYALGAN®||Hyalgan is not covered per medical policy. Refer to preferred products Synvisc or Synvisc-One.||M||05/01/15||04/01/16|
|HYCAMTIN®||Prior authorization for medical necessity is required.||P||01/01/12|
|HYCET™||The limits are 120mL per day.||P||05/15/09|
|HYDROCODONE/ACETAMINOPHEN||The limits are 12 tablets per day for 2.5mg-325mg tablets.||P||10/01/12|