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. 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.

 

Provider-Administered Precertification Drug List 

Provider-Administered Specialty Pharmacy Drug Management List