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|
|RASUVO®||Rasuvo may be subject to step therapy. Patients must have trial and failure of a generic injectable methotrexate.||P||07/01/15|
|RAVICTI||Prior authorization for medical necessity is required.||P||07/01/13|
|REBIF®||The limits are 3 syringes per week or 1 titration kit per 28 days.||P||10/01/12|
|RELENZA®||The limits are 20 blisters (1 carton) per 30 days.||P||12/03/01|
|RELISTOR®||Prior authorization for medical necessity is required.||P||08/06/08||10/01/11|
|RELPAX®||Relpax may be subject to step therapy. Patients must have trial and failure of a generic triptan (naratriptan, sumatriptan, rizatriptan). The limits are 12 tablets per 30 days.||P||11/01/05||07/01/15|
|REMICADE®||Predetermination for medical necessity is available.||M||01/01/15|
|RENOVA®||Prior authorization for medical necessity may be required.||P||04/01/01|
|REPATHA®||Prior authorization for medical necessity may be required. The quantity limits are 3 syringes per 30 days.||P||08/26/15||01/01/16|
|REPREXAIN®||The limits are 5 tablets per day.||P||05/15/09||04/01/12|
|RESCRIPTOR||The limits are 12 tablets per day for 100 mg tablets and 6 tablets per day for 200 mg tablets.||P||07/01/12||10/01/14|
|RETIN-A®||Prior authorization for medical necessity may be required.||P||04/01/01|
|RETROVIR||The limits are 6 capsules, 2 tablets, or 64 mL per day.||P||07/01/12|
|REVATIO®||Prior authorization for medical necessity is required.||P||04/01/15|
|REVLIMID®||Prior authorization for medical necessity is required. The limits are 1 capsule per day, except for 15 mg and 25 mg strengths which have a limit of 21 capsules per 28 days.||P||01/01/13|