Home - Medical Policies - Alabama
Provider-Administered Drug Forms
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. 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.To request a copy of a full drug policy, members can contact Customer Service by calling the number on their ID card.
Non-Oncology Drug Forms: