Products & Programs Federal Employee Program (FEP)CommercialNovember 1, 2023

Federal Employee Program specialty pharmacy prior authorization review

Effective for dates of service on or after February 1, 2024, the Federal Employee Program® (FEP) will require prior authorization (PA) review for the specialty drugs listed below. This applies to member IDs beginning with an “R”.

Prior to administering the drug(s) at any setting, PA must be completed to evaluate if the drug(s) meets clinical criteria. Care providers can request PA by calling FEP at 800-860-2156. Medications administered on or after February 1, 2024, without receiving PA will result in a denial of claims payment. If PA is denied for the drug not meeting medical necessity, care providers will follow the current disputed claim or service process.

FEP will continue to review the Federal Employee Medical Policy criteria for medical necessity on the drugs listed below. These changes do not impact the approval process for these specialty drugs obtained through pharmacy benefits.

For more information, contact Provider Services by calling the number on the back of your patient’s member ID card, or contact FEP at 800-860-2156.

Product name

Codes

Therapeutic category

Alymsys

Q5126

Bevacizumab

Amvuttra

J0225

Amyloidosis

Avastin

J9035, C9257

Bevacizumab

Beovu

J0179

Ocular VEGF

Byooviz

Q5124

Ocular VEGF

Cimerli

Q5128

Ocular VEGF

Eylea

J0178

Ocular VEGF

Fulphila

Q5108

Pegfilgrastim

Fylnetra

Q5130

Pegfilgrastim

Givlaari

J0223

AHP (Acute Hepatic Porphyria)

Granix

J1447

Filgrastim

Herceptin

J9355

Trastuzumab

Herceptin Hylecta

J9356

Trastuzumab

Kanjinti

Q5117

Trastuzumab

Lucentis

J2778

Ocular VEGF

Mvasi

Q5107

Bevacizumab

Neulasta

J2506

Pegfilgrastim

Neulasta/Onpro

J2506

Pegfilgrastim

Neupogen

J1442

Filgrastim

Nivestym

Q5110

Filgrastim

Nyvepria

Q5122

Pegfilgrastim

Ogivri

Q5114

Trastuzumab

Onpattro

J0222

Amyloidosis

Ontruzant

Q5112

Trastuzumab

Oxlumo

J0224

Primary Hyperoxaluria Type 1

Procrit

J0885

Erythropoietin

Releuko

Q5125

Filgrastim

Retacrit

Q5106

Erythropoietin

Riabni

Q5123

Rituximab

Rituxan

J9312

Rituximab

Rituxan Hycela

J9311

Rituximab

Rolvedon

J1449

Eflapegrastim

Ruxience

Q5119

Rituximab

Skyrizi

J2327

Autoimmune

Soliris

J1300

Complement Inhibitors

Stelara IV

J3358

Autoimmune

Stelara SQ

J3357

Autoimmune

Stimufend

Q5127

Pegfilgrastim

Tegsedi

C9399, J3490, J3590

Amyloidosis

Truxima

Q5115

Trastuzumab

Udenyca

Q5111

Pegfilgrastim

Vabysmo

J2777

Ocular VEGF

Vegzelma

Q5129

Bevacizumab

Vyvgart

J9332

Antimyasthenic Agents

Vyvgart Hytrulo

C9399, J3490, J3590

Antimyasthenic Agents

Zarxio

Q5101

Filgrastim

Ziextenzo

Q5120

Pegfilgrastim

Zirabev

Q5118

Bevacizumab

MULTI-BCBS-CM-041497-23-CPN41103

PUBLICATIONS: November 2023 Provider Newsletter