Skip to main content

FEP Prior Approval Documents

This page provides prior approval requirements, contact information, and forms for the Federal Employee Program (FEP).

Explore Prior Approval Topics

According to the terms of your coverage, prior approval is required for certain services and supplies and must be renewed periodically. This is outlined in the Blue Cross and Blue Shield Service Benefit Plan brochure, your official statement of benefits.

For prescription drugs and covered medical supplies, prior approval is required if the medication:

  • may be used outside the Food & Drug Administration or manufacturer's guidelines;
  • requires completion of diagnostic procedures to maximize the therapeutic benefits;
  • may be used to treat conditions or illnesses not covered by the Plan Benefit;
  • has unique dosing and/or administration requirements; or
  • has a high potential for adverse effects and/or abuse;
  • requires the previous use of one or more drugs before coverage is provided, known as step therapy.

Your physician can submit a Prior Authorization request electronically. Electronic Prior Authorization (ePA) is a fully electronic solution that processes PAs, formulary and quantity limit exceptions significantly faster!

  • ePA provides clinical questions ensuring all necessary information is entered, reducing unnecessary outreach and delays in receiving a determination. 
  • Receiving a decision faster allows patients to start therapy sooner. 
  • ePA is easily accessible through a web-based portal or may be integrated into your Electronic Health Record (EHR) platform 
  • ePA enables automated processing, resulting in a turnaround time of minutes to hours
    • Prescriber requests PA Question Set via EHR or online ePA portal
    • Prescriber completes PA Question Set, submits via EHR or online PA portal
    • PBM auto-scores, communicates decision via EHR or online ePA portal

Your physician can also contact our clinical call center toll-free at 1-877-727-3784 between the hours of 7 am and 9 pm Monday through Friday, Eastern Time, and request prior approval or quantity increases. Please note that this phone number is for physicians only.

  • Non-ePA relies on fax-based communication and manual review, resulting in a turnaround time of hours to days
    • Prescriber requests a fax of PA Question Set
    • Prescriber receives PA Question Set to complete via fax
    • Prescriber completes PA Question Set
    • Prescriber faxes PA Question Set answers back to PBM
    • PBM reviews Question Set answers, communicates decision or returns to prescriber for corrections or to acquire additional information
  • Did you know submitting prior authorizations (PAs) by fax or phone can take anywhere from 16 hours to 3 days to receive a determination?

Clinical information provided by your physician will ensure quick and accurate processing of your record. If you have questions about this process, please call the Retail Pharmacy Program toll-free at 1-800-624-5060.

Members looking to check status of a Prior Authorization may visit the Prior Authorization page.

For your convenience, you can print the prior approval drug list, which includes instructions for obtaining prior approval.

The Service Benefit Plan recognizes that some members and physicians prefer to use a paper-based process to obtain prior approval. You or your physician can choose the appropriate prior approval form. Both you and your physician will need to fill out the appropriate areas of the form and either fax or mail to the number/address in the upper right-hand corner of the form.

View recent updates to the prior approval program

CoverMyMeds

Surescripts

Access ePA through a web-based portal or an EHR-integrated solution. Choose one below.

 

Download Prior Approval Documents

Important Information

  • Some medications may require a previous use of one or more drugs before coverage is provided.
  • Some medications allow a certain quantity of medication before a Prior Approval is required.

If one of these scenarios applies to your medication, information can be found in the Criteria document available under the drug name.

View a list of medications that require step therapy and quantity limits before Prior Approval.

Read Less

Download, review and print the Prior Approval form for the requested medication. Select the starting letter of the name of the medication to begin. Use the arrows next to each medication name to expand your selection.

Read Less

Glossary results for letter A

Glossary results for letter B

Glossary results for letter C

Glossary results for letter D

Glossary results for letter E

Glossary results for letter F

Glossary results for letter G

Glossary results for letter H

Glossary results for letter I

Glossary results for letter J

Glossary results for letter K

Glossary results for letter L

Glossary results for letter M

Glossary results for letter N

Glossary results for letter O

Glossary results for letter P

Glossary results for letter Q

Glossary results for letter R

Glossary results for letter S

Glossary results for letter T

Glossary results for letter U

Glossary results for letter V

Glossary results for letter W

Glossary results for letter X

Glossary results for letter Y

Glossary results for letter Z

Back to top

Back to alphabetical documents listing