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 Guideline
TAFINLAR® Prior authorization for medical necessity is required. The limits are 4 capsules per day.
TALACEN The limits are 180 tablets per 30 days.
TAMIFLU® The limits are 20 capsules per 30 days for Tamiflu 30mg, 10 capsules per 30 days for Tamiflu 35mg and 75mg, and 180 mL per 30 days for Tamiflu 6mg/mL oral suspension.
TANZEUM® Tanzeum may be subject to step therapy requirements. Patients must have trial and failure of one or more of the following antidiabetic agents: metformin, sulfonylurea, combinations of metformin or sulfonylureas, or basal insulin (Lantus or Levemir). The limits are 4 vials per 28 days.
TARCEVA® Prior authorization for medical necessity is required. The limits are 1 tablet per day, except 25mg tablets with a limit of 2 tablets per day.
TARGRETIN® Prior authorization for medical necessity is required.
TASIGNA® Prior authorization for medical necessity is required. The limits are 4 capsules per day.
TAZAROTENE Prior authorization for medical necessity may be required.
TAZORAC® Prior authorization for medical necessity may be required.
TECFIDERA® The limits are 2 capsules per day and 1 starter kit per 30 days.
TEKAMLO® Tekamlo may be subject to step therapy requirements. Patients must have trial and failure of both of the following: 1) generic ACE inhibitor or generic ARB, AND 2) preferred brand ARB (Diovan, Exforge/HCT, Micardis/HCT).
TEKTURNA HCT® Tekturna HCT may be subject to step therapy requirements. Patients must have trial and failure of both of the following: 1) generic ACE inhibitor or generic ARB, AND 2) preferred brand ARB (Diovan, Exforge/HCT, Micardis/HCT).
TEKTURNA® Tekturna may be subject to step therapy requirements. Patients must have trial and failure of both of the following: 1) generic ACE inhibitor or generic ARB, AND 2) preferred brand ARB (Diovan, Exforge/HCT, Micardis/HCT).
TEMODAR® Prior authorization for medical necessity is required.
TESTIM® The limits are 10 grams per day.

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