Draft Provider-Administered Drug Policies

The drugs below 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.

Please use the Search function above to locate specific drug policy information.

 

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-0549 Uplizna™ (inebilizumab-cdon)
PH-90027 Cerezyme (imiglucerase)
PH-90091 Orencia® (abatacept)
PH-90104 Infliximab: Remicade®; Inflectra™; Renflexis™; Avsola™
PH-90105 Elelyso™ (taliglucerase alfa)
PH-90114 Soliris (eculizumab)
PH-90117 Stelara® (ustekinumab)
PH-90141 VPRIV® (velaglucerase alfa)
PH-90176 Simponi ARIA® (golimumab)
PH-90181 Visudyne® (verteporfin)
PH-90234 Colony Stimulating Factors – Pegfilgrastim: Neulasta®; Fulphila™; Udenyca®; Ziextenzo™; Nyvepria™
PH-90238 Botox® (onabotulinumtoxinA)
PH-90239 Dysport™ (abobotulinumtoxinA)
PH-90282 Testopel® (testosterone pellets)
PH-90284 Exondys-51™ (eteplirsen)
PH-90291 Spinraza™ (nusinersen)
PH-90305 Radicava (edaravone)
PH-90358 Ilumya™ (tildrakizumab-asmn)
PH-90362 Crysvita® (burosumab-twza)
PH-90468 Zolgensma® (onasemnogene abeparvovec-xioi)
PH-90503 Reblozyl (luspatercept-aamt)
PH-90520 Vyondys-53™ (golodirsen)