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|
|MACUGEN®||Predetermination for medical necessity is available.||M||01/01/15|
|MAGNACET®||The limits are 10 tablets per day for Magnacet 5/400mg. The limits are 8 tablets per day for Magnacet 7.5/400mg and 6 tablets per day for Magnacet 10/400mg.||P||09/01/04||04/01/13|
|MAKENA®||Predetermination for medical necessity is available.||M||01/01/15|
|MATULANE®||Prior authorization for medical necessity is required.||P||01/01/12|
|MAXAIR||The limits are 1 inhaler per 30 days.||P||04/01/12|
|MAXALT®||Maxalt may be subject to step therapy requirements. Patients must have trial and failure of a generic triptan (naratriptan, sumatriptan, rizatriptan). The limits are 18 tablets per 30 days.||P||11/01/05||07/01/15|
|MAXIDONE®||The limits are 5 tablets per day.||P||09/01/03|
|MEKINIST®||Prior authorization for medical necessity is required. The limits are 3 tablets per day for 0.5 mg strength and 1 tablet per for all other strengths.||P||01/01/14|
|METADATE CD®||The limits are 2 capsules per day, except Metadate CD 60mg which has a limit of 1 capsule per day.||P||01/01/05||04/01/11|
|METHADONE||The limits for the 5 mg/5 mL solution is 30 mL per day and the 10 mg/5 mL solution is 15 mL per day.||P||01/01/13|
|METHADOSE||The limits are 3 tablets per day or 3 mL of the 10 mg/mL concentrated solution per day.||P||01/01/13|
|METHITEST®||Prior authorization for medical necessity is required.||P||04/01/12|
|MEVACOR®||Mevacor may be subject to step therapy requirements. Patients must have trial and failure of generic statin (lovastatin, pravastatin, simvastatin).||P||01/01/11|
|MICARDIS HCT®||Micardis HCT may be subject to step therapy requirements. Patients must have trial and failure of a generic ACE Inhibitor or generic ARB.||P||01/01/11|
|MICARDIS®||Micardis may be subject to step therapy requirements. Patients must have trial and failure of a generic ACE Inhibitor or generic ARB.||P||01/01/11|