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Provider-Administered Drug Review Program
Blue Cross and Blue Shield of Alabama requires precertification of provider-administered drugs managed under a medical policy. Currently, precertification for these provider-administered drugs is required when administered in a provider's office, outpatient facility or home health setting. If precertification is not obtained, coverage will not be provided under the plan for the provider-administered drug. The Provider-Administered Precertification Drug List contains the list of drugs subject to the Provider-Administered Drug Review Program.
Precertification for oncology and non-oncology drugs can be initiated by following a link that appears in ProviderAccess Eligibility and Benefits for eligible members. Precertification review for provider-administered drugs is performed by Prime Therapeutics.
Find answers to questions about the Drug Wastage Program’s expansion through Prime Therapeutics.
Online policies can be found at AlabamaBlue.com/Providers/Policies.
If you have questions, contact your Provider Engagement Consultant at 1-866-904-4130.