Medications
The following medications or classes of medications require prior authorization. Medications may appear more than once. Please verify you are selecting the medication in the correct category to ensure you download the correct form. Please be aware that as new products are released and post-marketing information on existing therapies becomes available, changes in this list may occur. Physicians and pharmacy providers will be notified of any such changes via newsletters and direct mailings.
- Pharmacy Benefit Drugs
- Medical Benefit Drugs
- Medications (Quantity Limits)
- Federal Employee Advance Medical Review
Medications Not Found
All new-to-market medications will require a Prior Authorization. If the medication you are looking for is a new-to-market drug, or is not listed, please submit a Prior Authorization here.
Name Brand Medications with an available generic
Brand name drugs with an available generic requires the use of that generic. If there is a clinical reason the patient cannot use the generic, it is requires a Prior Authorization.
Pharmacy Benefit Drugs
ACA Pharmacy Medications Requiring Prior Authorization
Commercial Pharmacy Medications Requiring Prior Authorization
Submit a Pharmacy Benefit Prior AuthorizationMedical Benefit Drugs
ACA Medical Medications Requiring Prior Authorization
Commercial Medical Medications Requiring Prior Authorization
MA Medical Medications Requiring Prior Authorization
Submit a Medical Benefit Prior AuthorizationMedications (Quantity Limits)
Quantity limit refers to the amount of a drug needed to take the daily dose, according to the recommendations of the U.S. Food and Drug Administration (FDA). Quantity limits promote safe, cost-effective drug use and reduce waste and overuse. These limits are designed to control the use of selected drugs for quality and safety reasons. Prior authorization is required to go beyond the quantity limit.
The following list is subject to change and does not guarantee coverage. Use the search box at the top of this PDF to locate a specific drug.
Medications with Quantity Limits
Federal Employee Advance Medical Review
The following medications or classes of medications require advance review. Please verify you are selecting the medication in the correct category to ensure you download the correct form. Please be aware that as new products are released and post-marketing information on existing therapies becomes available, changes in this list may occur. Physicians and pharmacy providers will be notified of any such changes via newsletters and direct mailings.
- FEP Avastin Medical Review Request
- FEP to be paid under the Medical benefit for Federal members
- FEP Hyaluronic Acid Intra-Articular Injection
- FEP Neulasta Medical Review Request
- FEP Opdivo PA Request Form
- FEP Prolia Medical Review Request
- FEP Testosterone – Injection & Implant Medical Review Request
- FEP Xgeva Medical Review Request
- FEP Hyaluronic Acid Derivatives
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