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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 for our customers.

Real-Time Benefit Check Tool Coming Soon

Effective January 1, 2021, Real-Time Benefit Check (RTBC), a new drug cost transparency tool, will be available for your Blue Advantage® and BlueRx patients. RTBC is integrated with multiple electronic health record (EHR) platforms, making it convenient to use.

RTBC provides you with:

  • Accurate patient benefit information at the point of prescribing.
  • Up to three alternative clinically-equivalent drug recommendations that are a lower cost.
  • Alerts when a prior authorization or other approval is required.
  • A reduction in prior authorizations and pharmacy calls.

If you have questions about RTBC capability within your EHR, contact the EHR vendor used for your practice.

Blue Advantage (PPO) is a Medicare-approved PPO plan. Enrollment in Blue Advantage (PPO) depends on CMS contract renewal.

BlueRx (PDP) is a Medicare-approved Part D plan. Enrollment in BlueRx (PDP) depends on CMS contract renewal.

 

Drug Coverage Guidelines

Drug Coverage Lookup Tool

Blue Rx Coverage Determination and Prior Authorization Forms 

Blue Advantage Coverage Determination and Prior Authorization Forms

Participating Pharmacy Manual

Prescription Drug Guide 

Provider-Administered Drug Policies and Forms (Excluding Oncology)

Provider-Administered Oncology Drug Policies

Provider-Administered Precertification Drug List

Provider-Administered Specialty Drug List 

Self-Administered Drug Policies and Forms

Self-Administered Specialty Drug List

 

Drug Policy Provider Comments
We invite our participating physicians and other providers to submit scientific, evidence-based information, professional consensus opinions and other information supported by medical literature relevant to these draft policies for consideration. We receive comments for 45 days from the posting date listed on the document.
Provider-Administered Drug Review Program (Excluding Oncology)
A new online predetermination service that will streamline the authorization process for medical drugs (also known as provider-administered drugs).
High-Risk Medications Frequently Asked Questions
Frequently asked questions and answers about the High-Risk Medicaion List.
Pharmacy News
Drug Guide and Clinical Program Updates
How to View Pharmacy Benefit Information in ProviderAccess