DRAFT Self-Administered Drug Policies

Drug policies are based on:

  • information in FDA-approved package inserts (and black box warnings, alerts or other information disseminated by the FDA, as applicable);
  • research of current medical and pharmacy literature; and/or,
  • review of common medical practices in the treatment and diagnosis of disease.

Final and draft policies are published on this site. Draft policies are available for provider comment for 45 days from the posting date on the document. We encourage practicing physicians to provide input.

Note: Coverage is subject to member's specific benefits. Group-specific policies will supersede these policies, when applicable. Always verify member eligibilty and benefits.

Please use the Search function above to locate specific drug policy information.

Pharmacy Policies Disclaimer

Pharmacy drug policies are to provide a guide to coverage. Pharmacy policies are not intended to dictate to physicians how to practice medicine. Physicians should exercise their medical judgment in providing the care they feel is most appropriate for their patients.

 

How to Submit Comments on Draft Policies

Complete our policy feedback form online or send comments and supporting documentation to us by mail or fax:

Blue Cross and Blue Shield of Alabama
Attn: Pharmacy Department
P.O. Box 995
Birmingham, AL 35298-0001

Fax: 205-733-6471

 

Policy # Policy Title Print View
PH-1103 Firdapse (amifampridine)Prior Authorization with Quantity Limit Program Summary
PH-1104 Neurotrophic Keratitis Prior Authorization with Quantity Limit Program Summary
PH-1105 Weight Loss Agents Prior Authorization with Quantity Limit Program Summary
PH-1106 Arikayce Prior Authorization with Quantity Limit Program Summary
PH-1107 hATTR Amyloidosis Neuropathy Prior Authorization with Quantity Limit Program Summary
PH-91033 CGRP Prior Authorization with Quantity Limit Criteria
PH-91035 Circadian Rhythm Disorder Prior Authorization with Quantity Limit Program Summary
PH-91038 Emflaza Prior Authorization with Quantity Limit Program Summary
PH-91043 Growth Hormone Prior Authorization Program Summary
PH-91055 Lyrica Prior Authorization with Quantity Limit Program Summary
PH-91060 Northera Prior Authorization with Quantity Limit Program Summary
PH-91061 Nuvigil, Provigil Prior Authorization with Quantity Limit Program Summary
PH-91063 Oral Pulmonary Hypertension Agents Prior Authorization with Quantity Limit Program Summary
PH-91069 Self-Administered Oncology Agents Prior Authorization with Quantity Limit Summary
PH-91071 Selective Serotonin Inverse Agonist (SSIA)
PH-91074 Substrate Reduction Therapy Prior Authorization with Quantity Limit Program Summary
PH-91075 Thrombopoietin Receptor Agonists Prior Authorization with Quantity Limit Program Summary
PH-91077 Topiramate ER Prior Authorization with Quantity Limit Program Summary
PH-91092 Jynarque Prior Authorization with Quantity Limit Program Summary