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|
|VARUBI||The limits are 4 tablets per 30 days.||P||11/03/15||01/01/16|
|VECTIBIX®||Predetermination for medical necessity is available.||M||01/01/15|
|VELTIN®||Prior authorization for medical necessity may be required.||P||01/01/11|
|VENLAFAXINE EXTENDED-RELEASE||The limits are 1 tablet per day.||P||11/12/08|
|VENTAVIS®||Prior authorization for medical necessity is required. The limits are 9 packages of 30 ampules/30 days.||P||07/01/15|
|VENTOLIN HFA||The limits are 2 inhalers per 30 days.||P||04/01/12|
|VERAMYST®||The limits are 1 box per 30 days.||P||07/01/07|
|VIAGRA®||Prior authorization for medical necessity may be required. The limits are 8 tablets per 30 days. Patients must be at least 18 years of age.||P||07/01/98||10/18/02|
|VIBRAMYCIN®||Vibramycin capsules, suspension and syrup may be subject to step therapy requirements. Patients must have trial and failure of generic immediate release doxycycline AND generic immediate release minocycline.||P||04/01/13||01/01/15|
|VICODIN®||The limits are 8 Vicodin (5 mg hydrocodone) tablets, 6 Vicodin HP tablets, or 5 Vicodin ES tablets per day. Patients should not take more than a total of 4 grams of acetaminophen per day (3 grams per day if you have liver disease).||P||09/01/03|
|VICOPROFEN®||The limits are 5 tablets.||P||09/24/03||04/01/12|
|VICTOZA®||Victoza 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 3 pens (9mL) per 30 days.||P||02/15/10||04/01/11|
|VICTRELIS®||Prior authorization for medical necessity is required.||P||10/01/11|
|VIEKIRA®||Prior authorization for medical necessity is required.||P||01/22/15|
|VIRACEPT||The limits are 9 capsules per day for 250 mg and 4 tablets per day for 625 mg strengths.||P||07/01/12|