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. 

Search Policies

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

Browse Policies by Category

Use the navigation on the left to expand the menu and select specific medical policies by category.

 

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:

Provider-Administered Specialty Pharmacy Drug List