The Federal Employee Program (FEP) requires prior approval for certain high-cost drugs obtained outside of a pharmacy setting. The Blue Cross and Blue Shield Service Benefit Plan maintains a current list of high-cost prescription drugs. The full list of these select high-cost drugs requiring prior approval can be downloaded here: High-Cost Drug List.pdf (fepblue.org) Effective Jan. 1, 2024, FEP will add new prescription drugs to the existing High-Cost Drugs list. The table below lists all current high-cost drugs requiring prior approval and the new high-cost drugs that will require prior approval beginning Jan. 1, 2024. The high-cost drug list is updated quarterly and is subject to change without notice.
Coverage of and out-of- pocket costs for drugs on this list may be different under Standard Option, Basic Option, and FEP Blue Focus.
Healthcare providers can request prior approval by submitting a request through the Availity Essentials Provider Portal. If you do not have access to Availity Essentials, providers can use one of the following forms found on the BCBSND website. Providers can fax the request at 701-277-2971 or mail request and all records supporting the medical necessity of the request to:
ATTN: Utilization Management
4510 13th Ave S
Fargo, ND 58121