Final Provider-Administered Precertification 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.

Click the link below to locate specific drug policy information.
Final Provider-Administered Drug Policies

Precertification for the provider-administered drugs linked above is required when administered in a provider’s office, outpatient facility, or home infusion setting. Exceptions to this include: Gene and Cell therapies, and particular oncology treatments requiring an initial inpatient stay.

Urgent precertification requests must be called in to Prime Therapeutics at 1-800-424-8270.

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

Note: Coverage is subject to the member's specific benefits. Group-specific benefits will supersede these policies when applicable. Always check eligibility and benefits through your local Blue Plan provider portal or your practice management system to confirm member-specific benefits.