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|
|KADCYLA®||Prior authorization for medical necessity is required.||M||01/01/15||04/01/16|
|KADIAN®||The limits are 2 capsules per day.||P||05/15/09|
|KALBITOR®||Prior authorization for medical necessity is required when self-administered or physician-administered.||B||01/01/15||04/01/16|
|KALETRA||The limits are 6 tablets per day for 100 mg/25 mg, 4 tablets per day for 200 mg/50 mg, and 11 mL per day for 80 mg/20 mg per mL oral solution.||P||07/01/12||10/01/15|
|KALYDECO®||Prior authorization for medical necessity is required. The limits are 2 tablets or 2 packets per day.||P||07/01/12||07/01/15|
|KAZANO||The limits are 2 tablets per day.||P||04/01/13|
|KEVEYIS®||Prior authorization for medical necessity is required. The quantity limits are 4 tablets per day.||P||04/01/16|
|KEYTRUDA®||Prior authorization for medical necessity is required.||M||01/01/15||04/01/16|
|KHEDEZLA®||The limits are 30 tablets per 30 days.||P||01/01/14|
|KINERET®||Kineret may be subject to step therapy requirements. Patients must have trial and failure of two preferred products. Preferred products are Humira, Enbrel, Stelara and Simponi. The limits are 1 syringe per day.||P||07/17/02||07/01/15|
|KITABIS®||Prior authorization for medical necessity is required. Must not be used concurrently with Cayston or Bethkis.||P||04/01/15|
|KOMBIGLYZE® XR||The limits are 1 tablet per day, except Kombiglyze XR 2.5-1000mg which has a limit of 2 tablets per day.||P||04/01/15|
|KORLYM®||Prior authorization for medical necessity is required. The limits are 4 tablets per day.||P||10/30/15||01/01/16|
|KRYSTEXXA®||Prior authorization for medical necessity is required.||M||01/01/15||04/01/16|
|KYNAMRO||Prior authorization for medical necessity is required.||P||07/01/13|