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Effective August 1, 2023, precertification will be required on Part B provider-administered drugs for your Blue Advantage^® patients. If precertification is not obtained, coverage will not be provided under the plan for the provider-administered drugs. Precertification is managed by Prime Therapeutics.

Precertification will be required for the drugs indicated on the Blue Advantage Part B Provider-Administered Precertification Drug List when administered in the following places of service:

• Physician office (POS 11)
• Patient home (POS 12)
• Outpatient facility (POS 19, 22)

Gene therapy/cellular immunotherapy drugs indicated on the drug list require precertification in all places of treatment.

You will be able to initiate or check the status of a precertification for eligible patients by clicking the appropriate “Go” button on the Additional Coverage tab in Eligibility and Benefits.

For additional information, review our medical and drug policies at AlabamaBlue.com/Providers/Policies.

Blue Advantage Part B Drug Step Therapy Program

Effective January 1, 2025, certain drugs in the Part B Drug Step Therapy Program are changing from non-preferred to preferred status*. Review the list below to determine which drugs require precertification or are subject to step therapy (i.e., they will be approved with a valid prescription) for your Blue Advantage patients. 
 

Prime Therapeutics^® LLC, is an independent company contracted by Blue Cross and Blue Shield of Alabama to provide pharmacy benefit management services.