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.
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 Drug Lists: 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 Drug Lists: 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
Self-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 prescription/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 designated plan.
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.
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.
Provider-Administered Drug Review Program (Excluding Oncology): Online predetermination service that streamlines the authorization process for medical drugs (also known as provider-administered drugs).
AIM Specialty Health (AIM), an independent company, provides evidence-based cancer treatment information to physicians on behalf of Blue Cross and Blue Shield of Alabama.