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|
|SAIZEN®||Prior authorization for medical necessity is required. Use of the preferred growth hormone, Omnitrope, may be required.||P||10/01/11|
|SAIZEN® CLICK-EASY||Prior authorization for medical necessity is required. Use of the preferred growth hormone, Omnitrope, may be required.||P||01/01/13|
|SANCUSO®||Sancuso may be subject to step therapy requirements. Patients must have trial and failure of generic ondansetron or granisetron. The quantity limits are 1 patch per month.||P||11/12/08||10/01/15|
|SAVAYSA®||The limits are 30 tablets per month.||P||04/01/15|
|SEEBRI NEOHALER||The limits are 60 capsules per 30 days.||P||11/19/15||01/01/16|
|SELZENTRY||The limits are 2 tablets per day for 150 mg and 2 tablets per day for 300 mg strengths.||P||07/01/12||10/01/15|
|SEREVENT® DISKUS®||The limits are 2 blisters per day.||P||08/06/08|
|SEROSTIM®||Prior authorization for medical necessity is required. Use of the preferred growth hormone, Omnitrope, may be required.||P||10/01/11|
|SIGNIFOR®||Prior authorization for medical necessity is required. Quantity limits are 2ml/day.||P||07/01/13||01/01/16|
|SILENOR||The limits are 1 tablet per day.||P||07/01/11||07/01/13|
|SIMCOR®||Simcor may be subject to step therapy requirements. Patients must have trial and failure of generic statin (lovastatin, pravastatin, simvastatin).||P||01/01/11|
|SIMPONI ARIA||Prior authorization for medical necessity is required.||M||01/01/15||04/01/16|
|SIMPONI®||Step Therapy and Quantity Limits apply when self-administered.||P||05/06/09||01/01/16|
|SINGULAIR®||The limits are 1 tablet or packet per day.||P||01/01/00|
|SOLARAZE||Prior authorization for medical necessity is required. Limited to one 100 gram tube per 30 days.||P||01/01/16|