Certain medications may require predefined criteria before being approved for coverage. Other drugs may have daily or monthly limits recommended by the Food and Drug Administration, the drugs manufacturer, and/or peer-reviewed medical literature. These instances may require a doctors request for preapproval or prior authorization.
The following guidelines, developed by Blue Cross and Blue Shield of Alabama's Pharmacy and Therapeutics Committee, are meant to help members understand the requirements related to their pharmacy coverage. Healthcare providers should use their best medical judgment in providing the care they feel is most appropriate for their patients.
Please note: Some employer groups may have specific drug coverage requirements for their employees that are not included in the criteria below.
For more information please review Physician Administered Drug Policies.
Search by Drug Name
|Product Name||Implementation Date||Guideline|
|JAKAFI™||Prior authorization for medical necessity is required. The limits are 2 tablets per day.|
|JANUMET®||The limits are 2 tablets per day.|
|JANUMET® XR||The limits are 1 tablet per day, except 50 mg/1000 mg tablets which have a limit of 2 tablets per day.|
|JANUVIA®||The limits are 1 tablet per day.|
|JARDIANCE®||The limits are 1 tablet per day.|
|JENTADUETO®||The limits are 2 tablets per day.|
|JUVISYNC||The limits are 30 tablets per 30 days, except for the 50-10 mg and 50-20 mg strengths with a limit of 60 tablets per 30 days.|
|JUXTAPID||Prior authorization for medical necessity is required.|