| Icon | Restriction | Definition |
 | Age Limit Restriction | Coverage of this drug may be based on member age. |
 | Clinical Criteria | Click on the link for additional coverage details. |
 | Dose Optimization | Normally involves the conversion from twice-daily dosing to a once-daily dosing schedule. |
 | Dosing Limit | There are limits on the amount of medicine covered
within a certain amount of time. |
.gif "Generic Indicator") | Generic Indicator | Generics are simply copies of brand-name drugs. Brand-name and generic drugs have the same active ingredients, strength and dose. And the FDA requires that generic drugs meet the same high safety standards for purity, quality, safety and strength. |
 | Medical Benefit | Product is covered under the Medical Benefit. |
 | Over The Counter | Over the counter medication available with a prescription. (Prescribers please indicate OTC on the prescription). |
 | Prescriber Note | Additional notes for the prescriber. |
 | Prior Authorization | Prior authorization is the process of obtaining approval of benefits before certain prescriptions are filled. |
 | Quantity Limit | Certain prescription drugs have specific quantity limits per prescription or per month. |
 | State Carve-Out | The drug is covered through the Healthy Blue fee-for-service (FFS) program. |
 | Step Therapy | You may need to use one medication before benefits for the use of another medication can be authorized. |