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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.
Online policies can be found by selecting Provider-Administered Drug Policies under Pharmacy Resources on this website.
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 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 is available through our partnership with Magellan Rx Management. Precertification can be initiated by following a link that appears in ProviderAccess Eligibility and Benefits for eligible members.
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.
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.