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|
|ZALTRAP®||Prior authorization for medical necessity is required.||M||01/01/15||04/01/16|
|ZAMICET®||The limits are 90mL per day.||P||05/15/09|
|ZARXIO®||Prior authorization for medical necessity is required when physician-administered.||M||01/01/16||04/01/16|
|ZECUITY||Zecuity may be subject to step therapy requirements. Patients must have trial and failure of a generic triptan (naratriptan, sumatriptan, rizatriptan). The limits are 12 transdermal systems per 30 days.||P||07/01/13||07/01/15|
|ZEGERID®||Zegerid may be subject to step therapy requirements. Patients must have trial and failure of generic lansoprazole, omeprazole, pantoprazole, or rabeprazole. The limits are 1 capsule or packet per day.||P||08/01/06||04/01/14|
|ZELBORAF®||Prior authorization for medical necessity is required. The limits are 8 tablets per day.||P||01/01/12|
|ZERIT||The limits are 2 capsules or 80 mL per day.||P||07/01/12|
|ZETONNA||The limits are 1 bottle per 30 days.||P||07/01/12|
|ZIAGEN||The limits are 2 tablets or 32 mL per day.||P||07/01/12|
|ZIANA®||Prior authorization for medical necessity may be required.||P||07/01/07|
|ZIOPTAN||The limits are 1 single-use container per day.||P||07/01/12|
|ZOCOR®||Zocor may be subject to step therapy requirements. Patients must have trial and failure of generic statin (lovastatin, pravastatin, simvastatin).||P||01/01/11|
|ZOFRAN®||The limits are 21 tablets per 30 days for Zofran 4mg and 8mg, and 1 tablet per 30 days for Zofran 24mg.||P||02/01/05||04/01/12|
|ZOFRAN® ODT||The limits are 21 tablets per 30 days.||P||02/01/05|
|ZOHYDRO ER||The limits are 2 capsules per day.||P||04/01/14|