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PAP 268

Drug Replacement Policy

Provider Administrative Policy

Provider Information
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 Policy

If you have patients enrolled in a drug replacement program that replaces medication free of charge, but you need to submit a claim for the administration costs, please follow the instructions listed below:

When completing the prior authorization form for the medication, place a note on the prior authorization request indicating that the medication will be replaced to you at no cost by the drug company. Blue Cross of Idaho's Medical Management Department will append a note to the prior authorization in our system to instruct the claims examiner to zero-price the medication when processing the claims. This will allow consideration of the administration charges for covered medications but will not reimburse the medication. (See PAP 241 for medication prior authorization requirements.)

If the medication does not require prior authorization and you want paid for the administration costs, you need to bill both the medication and administration costs and then contact our Provider Contact Center to request recoupment of the medication payment after Blue Cross of Idaho adjudicates the claim. (See PAP100 for contact information.)

Policy History

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