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:
Your doctor can submit an electronic prior approval
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.
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.