PA Resources Portlet

Resources

EDUCATION & EVENTS

ENROLLMENT & CREDENTIALING

FORMS & MANUALS

PHARMACY

POLICIES & GUIDELINES

PRE-SERVICE REVIEW

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PHARMACY

Pharmacy Resources

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 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.

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.

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.