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MA PAP 106

Drug Replacement Program

Provider Administrative Policy

Policy Date
December 2011
New/December 2011
Provider Type(s)
All Providers  


Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.


Drug Replacement Program

Please follow the instructions below for your patients enrolled in a free of charge drug replacement program that requires claim submission for administration costs:

Include a note on the prior authorization request stating the drug company will supply you with replacement medication at no cost. Blue Cross of Idaho Medical Management department will supply this information to our claims examiners who will zero-price the medication during claims processing. This method allows consideration of administration charges but does not provide reimbursement for the covered medication. (See MAPAP 300, 301 & 303 for medication prior authorization requirements.)

If the medication does not require prior authorization and you wish to be paid for the administration costs, submit a claim for both the medication and administration costs. After submitting, contact our Provider Contact Center to request recoupment for the medication after the claim has been adjudicated. (See MAPAP 102 for contact information.)

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