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|
|NARCAN NASAL SPRAY||The limits are 1 package (2 nasal sprays) per 365 days.||P||04/01/16|
|NASACORT AQ®||The limits are 1 box per 30 days.||P||04/01/04|
|NASAREL®||The limits are 3 boxes per 30 days.||P||08/06/08||04/01/11|
|NASONEX®||The limits are 1 box – 17 g per 30 days.||P||02/22/05|
|NATESTO®||May be subject to step therapy requirements. Patients must have trial and failure of Androderm or Androgel. The limits are 180 pumps per 30 days.||P||07/01/15|
|NATPARA®||Prior Authorization for medical necessity is required. The limits are 14 packages of 2 cartridges per 28 days.||P||10/01/15|
|NESINA||The limits are 1 tablet per day.||P||04/01/13|
|NEULASTA®||Prior authorization for medical necessity is required when physician-administered.||B||04/01/15||01/01/16|
|NEUPOGEN®||Prior authorization for medical necessity is required when physician-administered.||B||04/01/15||01/01/16|
|NEVIRAPINE||The limits are 40 mL per day.||P||07/01/12|
|NEXAVAR®||Prior authorization for medical necessity is required. The limits are 4 tablets per day.||P||01/01/06|
|NEXIUM®||Nexium may be subject to step therapy requirements. Patients must have trial and failure of generic esomeprazole, lansoprazole, omeprazole, pantoprazole, or rabeprazole. The limits are 1 capsule or packet for oral suspension per day.||P||01/01/00||04/01/16|
|NICAZELDOXY® KIT||Nicazeldoxy may be subject to step therapy requirements. Patients must have trial and failure of generic immediate release doxycycline AND generic immediate release minocycline.||P||01/01/14||01/01/15|
|NINLARO®||Prior authorization for medical necessity is required. The quantity limites are 3 capsules per 28 days.||p||04/01/16|
|NORCO®||The limits are 12 for the 5 mg tablets and 6 for the 7.5 and 10 mg tablets per day. Patients should not take more than a total of 4 grams of acetaminophen per day (3 grams per day if you have liver disease).||P||09/01/03|