Draft Provider-Administered Drug Policies

Draft policies are listed below. If there are no policies listed, it means there are currently no policies in draft status.

Provider-administered oncology drugs require that a member’s medical condition meets the policy requirements prior to being given (precertification) unless otherwise specified.

Providers must submit a request through Prime Therapeutics for pre-service review in order to be approved. If the provider does not receive approval for precertification, the plan will pay no benefits.  

Currently, precertification for these provider-administered drugs is required when administered in a provider’s office, outpatient facility or home health setting; however, this precertification does not apply to inpatient hospital claims at this time.

Note: Coverage is subject to the member's specific benefits. Group-specific benefits will supersede these policies when applicable. Always check eligibility and benefits through your local Blue Plan provider portal or your practice management system to confirm member-specific benefits.

To request a copy of a drug policy, members can contact Customer Service by calling the number on their ID card.

Comment on Draft Oncology Drug Policies

Participating providers are invited to submit for consideration scientific, evidence-based information, professional consensus opinions and other information supported by medical literature relevant to draft policies.

Comments are accepted for 45 days from the posting date listed on the draft policy.

Make sure your voice is heard by providing feedback directly to us:

• Complete our policy feedback form online, or

• Send comments and supporting documentation by mail or fax

Birmingham Service Center
Attn: Health Management - Medical Policy
P.O. Box 10527
Birmingham, AL 35202

Fax: 205-220-0878

Draft Provider-Administered Drug Policies

Draft provider-administered drug policies are listed below. If there are no policies listed, it means there are currently no policies in draft status.

Note: Coverage is subject to the member's specific benefits. Group-specific benefits will supersede these policies when applicable. Always check eligibility and benefits through your local Blue Plan provider portal or your practice management system to confirm member-specific benefits. 

Comment on Draft Drug Policies

Participating providers are invited to submit for consideration scientific, evidence-based information, professional consensus opinions, and other information supported by medical literature relevant to our draft policies.

We accept comments for 45 days from the posting date listed on the draft policy.

Make sure your voice is heard by providing feedback directly to us:

• Complete our policy feedback form online or
   
• Send comments and supporting documentation to us by mail or fax:

Birmingham Service Center 
Attn: Pharmacy Department
P.O. Box 10527
Birmingham, AL 35202

Fax: 205-220-9576