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Provider-Administered Drug Review Program (Excluding Oncology)

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 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 Magellan Rx Management Drug Review for non-oncology drugs or AIM Specialty Health for oncology drugs. For information about precertification of provider-administered oncology drugs, refer to the Oncology Treatment Pathways Program.

Online policies can be found at AlabamaBlue.com/Providers/Policies.

We hosted Timely Topics webinars in June about the transition to Magellan Rx Management. Visit our Timely Topics web page to view or download a printable version of the Magellan Rx training presentation.

If you have questions, contact your Provider Networks Consultant at 1-866-904-4130.

HealthSmartRx Smart RxAssist – Blue Cross worked with HealthSmartRx (HSRx), an independent company, to implement the Smart RxAssist program effective November 1, 2021. Smart RxAssist offers savings to PEEHIP members through copay assistance. PEEHIP members are required to enroll in Smart RxAssist for medical benefit coverage of the provider-administered drugs in scope for this program. Other groups may add this program in 2022.

 

AIM Specialty Health is an independent company that partners with leading health plans to promote patient care that is appropriate, safe and affordable.

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