Blue Cross and Blue Shield of Alabama partners with Prime Therapeutics® LLC, an independent company, to provide drug management solutions. Review drug lists, drug policies, informational guides, and more by selecting from the links below.
Drug Lists
Provider-Administered Precertification Drug List: A list of provider-administered drugs that require precertification when administered in a provider’s office, outpatient facility or home health setting. Refer to this list to check if drugs require prior-authorization, must be obtained/billed by an in-network specialty pharmacy or if drugs may have limited distribution.
Provider-Administered Specialty Pharmacy Drug List: A list of provider-administered specialty medications that are generally prescribed for people with complex or ongoing medical conditions. Refer to this list to check if drugs require prior-authorization, must be obtained/billed by an in-network specialty pharmacy or if drugs may have limited distribution.
Self-Administered Specialty Pharmacy Drug List: A list of self-administered specialty medications that are generally prescribed for people with complex or ongoing medical conditions. Refer to this list to check if drugs require prior-authorization, must be obtained/billed by an in-network specialty pharmacy or if drugs may have limited distribution.
Drug Policies & Forms
Blue Advantage® Plan Overview: Review plan options, benefit information, and policies of the Blue Advantage (PPO), a Medicare Advantage plan.
BlueRxSM Plan Overview: Review plan options, benefit information and policies of the BlueRx (PDP) Medicare-approved Part D prescription drug plan.
Drug Policy Provider Comments Form: This form enables participating providers to submit evidence-based professional opinions relevant to draft policies for consideration. We accept comments for 45 days from the posting date listed on the policy.
Provider-Administered Drug Policies
Guides & Manuals
Drug Coverage Guidelines: Search by drug name to review drug guidelines, coverage benefits, implementation date and change date.
Fraud Prescription Schemes: Closely review any prescription requests or certificates of medical necessity received via fax from pharmacies or suppliers to avoid scams involving fraudulent prescriptions/orders faxed to physicians.
How to View Pharmacy Benefit Information in ProviderAccess: A step-by-step guide that helps navigate ProviderAccess to review pharmacy benefit information.
Participating Pharmacy Manual: A link to Prime Therapeutics pharmacy information and resources.
Prescription Drug Guide: This guide helps search a specific drug list by the designated plan.
Self-Administered Drug Policies
Pharmacy Information & Tools
Drug Coverage Lookup Tool - Search and verify drug coverage by providing the contract number and drug name.
High-Risk Medications Frequently Asked Questions: Frequently asked questions and answers about the high-risk medication list.
Pharmacy News: Drug Guide and Clinical Program Updates.
Real-Time Benefit Check Tool (RTBC) - a drug cost transparency tool available for Blue Advantage patients. RTBC is integrated with multiple electronic health record platforms for provider convenience.
Statin Reference Guide - Blue Advantage®: Use this guide as a quick reference for the Statin Therapy for Patients with Cardiovascular Disease (SPC) and Statin Use in Persons with Diabetes (SUPD) quality measures for your Blue Advantage patients.
Programs
Biometric Screening Program: The Biometric Screening Program works in conjunction with the wellness programs set by participating employer groups. These screenings may be performed by a pharmacist at a participating pharmacy in our network.
HealthSmartRx Smart RxAssist: Smart RxAssist offers savings through copay assistance for eligible members who are prescribed specific provider-administered specialty drugs.
Pharmaceutical Assistance Programs - View our Pharmaceutical Assistance Programs flier to help patients who need medications but have limited financial resources.
Provider-Administered Drug Review Program (Excluding Oncology): Online predetermination service that streamlines the authorization process for medical drugs (also known as provider-administered drugs).
Rx Savings Solutions:
Most patients, including those with Blue Advantage® and BlueRx℠ plans, can use Rx Savings Solutions to easily find out if they have lower-cost drug options available based on their benefits. View our Rx Savings Solutions Informational flyer for details. Rx Savings Solutions pharmacy technicians may contact your office via phone or fax (view sample) on behalf of patients to obtain approval.
For additional information, contact Rx Savings Solutions at 1-800-268-4476 or email support@RxSavingsSolutions.com.
FORMS & MANUALS