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
LANSOPRAZOLE The limits are 1 capsule or solutab per day. P 01/01/00
LAZANDA® Prior authorization for medical necessity is required. Patients must have trial and failure of generic product. The limits are 1 bottle per day. P 01/01/12 10/01/15
LEMTRADA® Prior authorization for medical necessity is required. M 01/01/15 04/01/16
LENVIMA® Prior authorization for medical necessity is required. Quantity limits are in place and vary based on strength. P 04/01/15
LESCOL XL® Lescol XL may be subject to step therapy requirements. Patients must have trial and failure of generic statin (lovastatin, pravastatin, simvastatin). P 01/01/11
LESCOL® Lescol may be subject to step therapy requirements. Patients must have trial and failure of generic statin (lovastatin, pravastatin, simvastatin). P 01/01/11
LETAIRIS® Prior authorization for medical necessity is required. P 04/01/15
LEUKINE® Prior authorization for medical necessity is required when physician-administered. B 04/01/15 04/01/16
LEVITRA® Prior authorization for medical necessity may be required. The limits are 8 tablets per 30 days. Patients must be at least 18 years of age. P 09/01/03
LEVORPHANOL The limits are 4 tablets per day. P 01/01/13
LEXIVA The limits are 4 tablets per 60 mL per day. P 07/01/12
LEXXEL® Lexxel may be subject to step therapy requirements. P 01/01/11
LINZESS® Prior authorization for medical necessity is required. P 04/01/13
LIPITOR® Lipitor may be subject to step therapy requirements. Patients must have trial and failure of generic statin (lovastatin, pravastatin, simvastatin). P 01/01/11
LIPTRUZET® Liptruzet may be subject to step therapy requirements. Patients must have trial and failure of generic statin (lovastatin, pravastatin, simvastatin). P 07/01/13