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|
|PANTOPRAZOLE||The limits are 1 tablet per day.||P||07/01/10||04/01/11|
|PATANASE®||The limits are 1 box per 30 days.||P||08/06/08|
|PEG-INTRON®||Prior authorization for medical necessity is required. Use of the preferred peginterferon, Pegasys, may be required.||P||06/01/06||01/01/11|
|PEGASYS®||Prior authorization for medical necessity is required.||P||06/01/06||01/01/11|
|PERCOCET®||The limits are 12 tablets for the 2.5 mg and 5 mg oxycodone tablets, 8 tablets for the 7.5 mg tablets, and 6 tablets for the 10 mg tablets per day.||P||09/01/04|
|PERCODAN®||The limits are 12 tablets per day.||P||03/29/04|
|PERJETA®||Predetermination for medical necessity is available.||M||01/01/15|
|PHRENILLIN FORTE||The limits are 6 capsules per day.||P||04/01/13|
|PICATO||The limits are 3 tubes per 90 days of the 0.015% gel and 2 tubes per 90 days of the 0.05% gel.||P||04/01/13|
|PLEGRIDY®||The limits are 2 syringes or pens per 30 days and 1 starter kit per 180 days.||P||01/01/15|
|POMALYST®||Prior authorization for medical necessity is required. The limits are 21 capsules per 28 days.||P||04/01/13|
|PRADAXA®||The limits are 2 capsules per day.||P||04/01/11|
|PRALUENT®||Prior authorization for medical necessity is required. The limits are 2 syringes per 28 days.||P||07/24/15|
|PRAVACHOL®||Pravachol may be subject to step therapy requirements. Patients must have trial and failure of generic statin (lovastatin, pravastatin, simvastatin).||P||01/01/11|
|PREVACID®||Prevacid may be subject to step therapy requirements. Patients must have trial and failure of generic lansoprazole, omeprazole, pantoprazole, or rabeprazole. The limits are 1 capsule, solutab, or packet per day.||P||01/01/00||04/01/14|