Member Policies - Medical Policies - Alabama
Policies & Guidelines
- Advanced Imaging
- Autism Spectrum Mandate
- Behavioral Health
- Blue Advantage Policies
- Chronic Condition Management
- Genetic Testing Management
- Hemophilia Drug Management
- Medical Policies
- Provider-Administered Drug Policies (Excluding Oncology)
- Provider-Administered Oncology Drug Policies
- Radiation Therapy Management (RTM)
- Self-Administered Drug Policies
- Transgender Services
Self-Administered Drug Forms
Drug policies are based on:
- information in FDA-approved package inserts (and black box warnings, alerts or other information disseminated by the FDA, as applicable);
- research of current medical and pharmacy literature; and/or,
- review of common medical practices in the treatment and diagnosis of disease.
Note: Coverage is subject to member's specific benefits. Group-specific policies will supersede these policies, when applicable. Always verify member eligibilty and benefits.
Forms:
Buprenorphine and Buprenorphine/Naloxone Prior Authorization Form
Compound Coverage Authorization Request Form
General Prescription Drug Authorization Request Form
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