Prior Approval

Helping you understand the prior approval process.

CORONAVIRUS UPDATE: FEP will waive prior authorizations for medically necessary diagnostic tests and covered services that are consistent with CDC guidance if diagnosed with COVID-19. Learn more here.

What is Prior Approval?

Some prescription drugs and supplies need approval before we cover them. This is known as prior approval. We need to confirm two things:

  • You’re using the drug to treat something we cover
  • Your doctor prescribes it in a medically appropriate way

We require prior approval if the drug:

  • May be used outside the Food & Drug Administration or drug maker’s guidelines
  • Requires you to have tests to make sure the drug is effective for you
  • May be used to treat conditions or illnesses we do not cover
  • Has unique dosing and/or administration requirements
  • Is known to have bad side-effects and/or to be abused

You can view the current prior approval list here. We review and update the list often.

How to Obtain Prior Approval

There are three ways to get Prior Approval:

  1. Your doctor can submit an electronic prior approval
  2. Your doctor can  call us toll-free at 1-877-727-3784 between 7 a.m. and 9 p.m. Monday through Friday, Eastern time. This phone number is only for doctor’s offices.
  3. Your doctor can submit a paper prior approval.  You can download a form on the Prior Approval Page.


If you have questions about this process, please call the Retail Pharmacy Program toll-free at 1-800-624-5060.

Thank You for Being a Caregiver
We pledge to honor and support all caregivers who are vitally needed at this time. Because we’re in this together. You can learn more here.

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