EDUCATION & EVENTS
ENROLLMENT & CREDENTIALING
FORMS & MANUALS
POLICIES & GUIDELINES
PROGRAMS & INITIATIVES
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. Precertification for drugs included in this program will be required for dates of service April 1, 2016, and after according to member benefits. Currently, precertification for these provider-administered drugs is required when administered in a provider's office or home health setting; however, this precertification does not apply to outpatient facility claims or inpatient hospital claims at this time. 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.
Online policies and forms can be found by selecting "Provider-Administered Drug Policies and Forms" under Pharmacy Resources on this website.
Precertification reviews for provider-administered drugs are performed by either Prime Medical Drug Review for non-oncology drugs or by AIM Specialty Health for oncology drugs. For oncology precertification of provider administered drugs, please reference the Oncology Select Program.
To facilitate requests for a precertification review for non-oncology drugs, Blue Cross offers a paperless service that streamlines the authorization process with single sign-on functionality.. This free online service called CoverMyMeds is available through our partnership with Prime Therapeutics. A precertification can be initiated by following a link that appears in ProviderAccess Eligibility and Benefits for eligible members. See "How to Initiate a Provider-Administered Drug Precertification."
If you have questions, contact your Provider Networks Consultant at 1-866-904-4130.
CoverMyMeds is available to Blue Cross and Blue Shield of Alabama through Prime Therapeutics, an independent company providing pharmacy benefit management services. CoverMyMeds is an independent company that provides electronic solutions for drug prior authorizations.
AIM Specialty Health is an independent company that partners with leading health plans to promote patient care that is appropriate, safe and affordable.