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
OCTAGAM® Predetermination for medical necessity is available. M 01/01/15 01/01/16
OCUDOX® KIT Ocudox may be subject to step therapy requirements. Patients must have trial and failure of generic immediate release doxycycline AND generic immediate release minocycline. P 04/01/13 01/01/15
ODOMZO Prior authorization for medical necessity is required. The limits are 1 capsule daily. P 10/08/15 01/01/16
OFEV® Prior authorization for medical necessity is required. The limits are 2 tablets per day. P 10/20/14
OMEPRAZOLE The limits are 1 capsule per day. P 01/01/00
OMEPRAZOLE-SODIUM BICARBONATE Omeprazole-sodium bicarbonate may be subject to step therapy requirements. Patients must have trial and failure of generic lansoprazole, omeprazole, pantoprazole, or rabeprazole. The limits are 1 tablet per day. P 07/01/10 04/01/14
OMNARIS® The limits are 1 box per 30 days. P 08/06/08
OMNITROPE® Prior authorization for medical necessity is required. P 10/01/11
ONGLYZA® The limits are 1 tablet per day. P 08/27/09
ONSOLIS™ Prior authorization for medical necessity is required. The limits are 4 tablets per day. P 09/18/09
OPANA ER® The limits are 2 tablets per day. P 02/15/07
OPANA® The limits are 6 tablets per day. P 01/01/13
OPDIVO® Predetermination for medical necessity is available. M 01/01/15
OPSUMIT® Prior authorization for medical necessity is required. P 04/01/15
ORACEA® Oracea may be subject to step therapy requirements. Patients must have trial and failure of generic immediate release doxycycline AND generic immediate release minocycline. P 04/01/13 01/01/15