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The Policy VaultThe Policy Vault

Nora-be — Blue Cross Blue Shield of Alabama

Medically necessary conditions such as acne vulgaris (hormonal treatment or in conjunction with isotretinoin therapy), amenorrhea, dysfunctional uterine bleeding, dysmenorrhea, endometriosis, fibroid uterus, hyperandrogenism (hirsutism), irregular menses (menorrhagia, oligomenorrhea, hypermenorrhea), menstrual migraine, ovarian cysts, ovarian/endometrial cancer prevention (family history of ovarian or endometrial cancer), perimenopause, polycystic ovarian syndrome, premenstrual dysphoric disorder (PMDD)

Initial criteria

  • Contraceptive is being prescribed to treat one of the accepted medically necessary conditions as listed.
  • Other medical conditions not listed will be reviewed on a case-by-case basis.

Reauthorization criteria

  • Same as initial criteria.

Approval duration

12 months