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. 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