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.
For more information please review Physician Administered Drug Policies.
Search by Drug Name
|Product Name||Implementation Date||Change Date||Guideline|
|QNASL CHILDREN®||The limits are 1 inhaler per month.|
|QNASL®||The limits are 1 bottle per 30 days.|
|QUALAQUIN®||01/01/12||The limits are 42 capsules per 90 days, which allows for a single 7-day course of therapy.|
|QUILLIVANT XR||The limits are 360 mL per 30 days.|
|QVAR®||04/01/11||The limits are 1 boxes per 30 days for 40mcg strength and 3 boxes per 30 days for 80mcg 7.3 grams and 2 boxes per 30 days for 80mcg 8.7 grams.|