Category Filter
Policies & Guidelines
- Advanced Imaging
- Autism Spectrum Mandate
- Behavioral Health
- Chronic Condition Management
- Genetic Testing
- Hemophilia Drugs
- Medical Policies
- Pre-Service Review (Precertification/Predetermination)
- Provider-Administered Drug Policies (Excluding Oncology)
- Provider-Administered Oncology Drug Policies
- Radiation Therapy
- Self-Administered Drug Policies
- Transgender Services
Asset Publisher
Self-Administered Drug Prior Authorization Forms
Drug policies are based on:
- information in FDA-approved package inserts (and black box warnings, alerts or other information disseminated by the FDA, as applicable);
- research of current medical and pharmacy literature; and/or,
- review of common medical practices in the treatment and diagnosis of disease.
Note: Coverage is subject to member's specific benefits. Group-specific policies will supersede these policies, when applicable. Always verify member eligibilty and benefits.
Forms
Click on the appropriate link below to print the form to request prior authorization for these drugs:
Node: bclrpolappp1001.corp.bcbsal.org:8080: