Certain medications may require predefined criteria before being approved for coverage. Other drugs may have daily or monthly limits recommended by the Food and Drug Administration, the drugs manufacturer, and/or  peer-reviewed medical literature. These instances may require a doctors request for preapproval or prior authorization.

 

The following guidelines, developed by Blue Cross and Blue Shield of Alabama's Pharmacy and Therapeutics Committee, are meant to help members understand the requirements related to their pharmacy coverage. Healthcare providers should use their best medical judgment in providing the care they feel is most appropriate for their patients.

 

Please note: Some employer groups may have specific drug coverage requirements for their employees that are not included in the criteria below.

Search by Drug Name

Product Name Implementation Date Guideline
OCUDOX® KIT 04/01/13 Ocudox may be subject to step therapy requirements. Patients must have trial and failure of generic immediate release doxycycline.
OFORTA™ 12/22/09 Prior authorization for medical necessity is required.
OMEPRAZOLE 01/01/00 The limits are 1 capsule per day.
OMEPRAZOLE-SODIUM BICARBONATE 07/01/10 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.
OMNARIS™ 08/06/08 The limits are 1 box per 30 days.
OMNITROPE® 10/01/11 Prior authorization for medical necessity is required.
ONGLYZA™ 08/27/09 The limits are 1 tablet per day.
ONSOLIS™ 09/18/09 Prior authorization for medical necessity is required. The limits are 4 tablets per day.
OPANA ER® 02/15/07 The limits are 2 tablets per day.
OPANA® 01/01/13 The limits are 6 tablets per day.
ORACEA® 04/01/13 Oracea may be subject to step therapy requirements. Patients must have trial and failure of generic immediate release doxycycline.
ORAMORPH® SR 05/15/09 The limits are 3 tablets per day.
ORAXYL® 04/01/13 Oraxyl may be subject to step therapy requirements. Patients must have trial and failure of generic immediate release doxycycline.
ORBIVAN 04/01/13 The limits are 6 capsules per day.
ORBIVAN CF 04/01/13 The limits are 6 tablets per day.

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