Federal Employee Program (FEP) Medical Prior Authorization Drug List
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Lists drugs within the Federal Employee Program (FEP) that require prior authorization and identifies therapeutic classes; intended for providers and prior authorization reviewers submitting and reviewing requests through Novologix for Blue Cross and Blue Shield Federal Employee Program.
No material clinical or coverage changes in this revision.
Coverage Criteria
This list document does not contain detailed medical necessity criteria or exclusions. Detailed coverage criteria and exclusions are contained in the FEP Medical Policy Manual available on fepblue.org; this list only identifies drugs within the Federal Employee Program that require prior authorization.
Provider Actions and Prior Authorization Requirements
Prior authorization required for listed drugs
Drugs listed in this FEP Medical Prior Authorization Drug List require prior authorization under the Blue Cross and Blue Shield Federal Employee Program and must be submitted and reviewed through Novologix.
Submit and review requests via Novologix
Providers must submit and review prior authorization requests through Novologix per the FEP process and refer to the FEP Medical Policy Manual on fepblue.org for specific criteria.
Denial risk if not submitted through Novologix
Failure to submit prior authorization requests through Novologix for drugs on this list may result in denial of coverage or lack of prior authorization.
Background
This document serves as the Federal Employee Program (FEP) prior-authorization drug list. It groups medications by therapeutic class and identifies those that are medically benefitted but require prior authorization. Providers and reviewers must submit and review requests for the listed drugs through Novologix as part of the FEP prior-authorization process.
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