Member Policies - Medical Policies - Alabama
- Autism Spectrum Mandate
- Behavioral Health
- Blue Advantage Medical Policies
- Chronic Condition Management
- Medical Policies
- PET, MRI, MRA, CT, CTA/CCTA
- Provider-Administered Drug Policies (Excluding Oncology)
- Provider-Administered Oncology Drug Policies
- Radiation Therapy Management (RTM)
- Self-Administered Drug Policies
- Transgender Services
Provider-Administered Drug Policies
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. Currently, precertification for these provider-administered drugs is required when administered in a provider’s office or home health setting; however, this precertification does not apply to inpatient hospital claims at this time. Precertification for the drugs listed below will be required in the outpatient facility setting beginning April 1, 2019. Exceptions to this exist at this time: Luxturna, Kymriah and Yescarta require a precertification for any place of treatment. To request a copy of a full drug policy, members can contact Customer Service by calling the number on their ID card.