Draft Provider-Administered Drug Policies

The drugs below require that a member’s medical condition meets the policy requirements prior to being given (precertification) unless otherwise specified. 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 is required in the outpatient facility setting. Exceptions to this include: Luxturna, Kymriah and Yescarta, which require a precertification for any place of treatment.

Members can request a copy of a full drug policy, by calling the Customer Service number on their ID card.

 

How to Submit Comments on Draft Policies

Complete our policy feedback form online or send comments and supporting documentation to us by mail or fax:

Blue Cross and Blue Shield of Alabama
Attn: Pharmacy Department
P.O. Box 995
Birmingham, AL 35298-0001

Fax: 205-733-6471

 

Policy # Policy Title Print View
PH-90109 Rituximab: Rituxan®, Truxima®, Ruxience®, Riabni™
PH-90146 Xolair (omalizumab)
PH-90238 Botox® (onabotulinumtoxinA)
PH-90239 Dysport™ (abobotulinumtoxinA) (Precertification not required)
PH-90240 Myobloc® (rimabotulinumtoxinB)
PH-90241 Xeomin (incobotulinumtoxinA) (Precertification not required)
PH-90242 Aranesp® (darbepoetin alfa)
PH-90243 Epoetin alfa: Epogen®; Procrit®; Retacrit™ (Precertification not required)
PH-90244 Mircera® (methoxy polyethylene glycol-epoetin beta) (Precertification not required)
PH-90362 Crysvita® (burosumab-twza)