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Provider-Administered Oncology Drug Policies

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

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

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.

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Use the navigation on the left to expand the menu and browse specific medical or drug policies by category.

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Use the search function above to find medical or drug policies by name, number or keyword.

Provider-Administered Oncology Drugs Precertification

Precertification through Magellan Rx is required for provider-administered oncology drugs. 

How to submit a precertification request to Magellan Rx:

Online

Go to your local plan's provider portal to initiate pre-service review (Electronic Provider Access) for these services for out-of-area members. Contact your local Blue Plan for more information on how to access this functionality in your local provider portal.

By Phone

  • Call Magellan Rx at 1-800-424-8270
  • Urgent requests must be called in to Magellan Rx. Do not submit urgent requests online.