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|
|ULORIC®||Uloric may be subject to step therapy requirements. Patients must have a trial and failure of allopurinol 300mg.||P||07/20/09||07/01/11|
|ULTRACET®||The limits are 8 tablets per day.||P||04/01/07||04/01/12|
|ULTRAM ER®||The limits are 1 tablet per day.||P||02/15/06||04/01/12|
|ULTRAM®||The limits are 8 tablets per day.||P||09/04/02||04/01/12|
|UPTRAVI®||Prior authorization for medical necessity is required. The quantity limits are 60 tabs per 30 days and 1 titration pack per 180 days.||P||01/20/16|
|UTIBRON NEOHALER||The limits are 60 capsules per 30 days.||P||11/19/15||01/01/16|