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Current Provider-Administered Drug Policies - Blue Advantage®
Note: Coverage is subject to the member's specific benefits. Group-specific policies will supersede these policies when applicable. Please refer to the member's benefit plan.
Blue Advantage Part B Provider-Administered Drug Precertification Program
Precertification through Prime Therapeutics is required for the provider-administered drugs on the following list when administered in a provider's office, outpatient facility or home health setting. Treatments indicated as gene therapy/cellular immunotherapy require precertification when administered in any place of treatment.
Blue Advantage Part B Provider-Administered Drug Precertification List
How to submit a precertification request to Prime Therapeutics
Refer to the member's eligibility and benefits to initiate or check the status of a pre-service review.
Prime Therapeutics® LLC is an independent company providing medical review services on behalf of Blue Cross and Blue Shield of Alabama.
Blue Advantage Part B Provider-Administered Drug Policies
National Coverage Determinations
Refer to the following to search for National Coverage Determinations:
Local Coverage Determinations
For Local Coverage Determinations, refer to the following sites:
Reasonable and Necessary Guidelines
In the absence of a National Coverage Determination, Local Coverage Determination or CMS Manual Instruction, reasonable and necessary guidelines still apply.
Refer to the original Medicare manual Pub. 100-02, Chapter 15, Sec. 50 Drugs and Biologicals.