Member Policies - Medical Policies - Alabama
- Advanced Imaging
- Autism Spectrum Mandate
- Behavioral Health
- Blue Advantage Policies
- Chronic Condition Management
- Genetic Testing
- HealthSmartRx Medical Drug Copay Maximizer Program
- Hemophilia Drugs
- Medical Policies
- Provider-Administered Drug Policies (Excluding Oncology)
- Provider-Administered Oncology Drug Policies
- Radiation Therapy
- Self-Administered Drug Policies
- Transgender Services
Provider-Administered Drug Policies (Excluding Oncology Drugs)
Provider-administered drugs 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.
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Note: Members can request a copy of a drug policy by calling the Customer Service number on their ID card.
Provider-Administered Drugs Requiring Precertification
Precertification through Magellan Rx is required for the provider-administered drugs on the following list when administered in a provider’s office, outpatient facility or home health setting; precertification does not apply to inpatient hospital claims at this time:
Provider-Administered Precertification Drug List
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.
Provider-Administered Specialty Drugs
The provider-administered specialty medications on the list below must be obtained and billed by an in-network medical specialty pharmacy: