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Blue Advantage Part B Provider-Administered Drug Precertification Program

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 Magellan Rx Management.

Patients receiving medication on the precertification drug list prior to August 1, 2023, have an authorization in our system through December 31, 2023, for continued claims payment. On January 1, 2024, continued coverage will require valid precertification through Magellan Rx.

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, 2024, Part B drugs identified as “preferred products” in the list below will not require precertification or be subject to step therapy (i.e., they will be approved with a valid prescription) for Blue Advantage patients.

Part B drugs identified as “non-preferred products” will be subject to step therapy and precertification requirements. This means that patients will need to try a preferred Part B drug before they can be approved for a non-preferred Part B drug.

Note: Patients utilizing these Part B drugs within the past 365 days, as verified by claim(s), will not need precertification during the grace period through May 31, 2024. After the grace period ends, patients will be subject to precertification requirements.

Review the Part B Preferred and Non-Preferred Step Therapy Drug List below:
 

  Preferred Products
(No Step Therapy or Precertification Required)
Non-Preferred Products          (Subject to Step Therapy and Precertification Requirements)

Rituximab    

  • Truxima
  • Ruxience
  • Rituxan
  • Rituxan Hycela
  • Riabni
Trastuzumab    
  • Kanjinti
  • Trazimera
  • Herceptin
  • Herceptin Hylecta
  • Herzuma
  • Ogivri
  • Ontruzant
Bevacizumab (oncology uses only)
  • Mvasi
  • Zirabev    
  • Alymsys
  • Avastin
  • Vegzelma

 

Magellan Rx ManagementSM is an independent company providing medical review services on behalf of Blue Cross and Blue Shield of Alabama.