Final Provider-Administered Drug Policies

The drugs below require that a member’s medical condition meets the policy requirements prior to being given (precertification). Providers must submit a request 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. Exceptions to this include: Gene and Cell therapies, and particular oncology treatments requiring an initial inpatient stay.

Urgent precertification requests must be called in to Prime Therapeutics at 1-800-424-8270.

Members can request a copy of a full drug policy by calling the Customer Service number on their ID card

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. 

Final Provider-Administered Drug Policies

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

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. 

Precertification for these provider-administered drugs is required when administered in a provider’s office, outpatient facility, or home health setting. 

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.

Urgent precertification requests must be called in to Prime Therapeutics at 1-800-424-8270.