Resources

This section only applies if your patient is covered by the Federal Employee Program (FEP).

The FEP Pharmacy and Medical Policy Committee (PMPC) is an independent group of doctors and pharmacists. This group recommends drugs for each tier based on their effectiveness, safety, and how they compare to other drugs in the same therapeutic class. The PMPC meets quarterly to review new and existing drugs. The Committee’s recommendations, together with our evaluation of the relative cost of the drugs, determine the placement of formulary drugs on a specific tier. Quarterly updates to the formulary drug lists are posted prior to the effective date of the changes at www.fepblue.org/formulary. Members and their providers are notified of any formulary changes that negatively impact members.

A list of drugs that require prior approval, step therapy or that have dispensing limits can be found at http://www.fepblue.org/pharmacy/prescriptions.  

Certain physician-administrated prescription drugs require prior approval. A list of these drugs can be found at www.fepblue.org/pharmacy/prescriptions in the section title “We also require prior approval for select high-cost drugs when using your medical benefits.”

Generally, the lower the drug tier, the lower the cost. Coverage and member cost vary based on the Plan. Tier assignments for prescription drugs are based on recommendations from the PMPC.
The FEP Blue Standard and Basic Option Benefit Plans group drugs into these five tier levels:

• Tier 1 – Generic Drugs
• Tier 2 – Preferred Brand Drugs
• Tier 3 – Non-preferred Brand Drugs
• Tier 4 – Preferred Specialty Drugs
• Tier 5 – Non-preferred Specialty Drugs

The FEP Focus Plan groups drugs into these two tier levels:

• Tier 1 – Preferred Generics
• Tier 2 – Preferred Brand Name Drugs, Preferred Generic Specialty and Preferred Brand Name Specialty 

Prescription drugs are classified as either brand or generic. Blue Cross uses the brand or generic status provided by a nationally recognized company providing drug product information. The brand/generic status of a drug can sometimes change over the life of the drug and can change from brand to generic or from generic to brand. These changes may alter the amount the member pays for the drug. The brand or generic status of a drug is never based upon a product having a trade name. Generic drugs often have trade names.

Blue Cross encourages generic utilization as a way to provide high-quality drugs at a reduced cost. Generic drugs are as safe and effective as their brand counterparts, but are usually less expensive. Generic drugs are manufactured under the same strict requirements of the FDA’s Current Good Manufacturing Practice regulations required for brand drugs and cover the manufacturing, identity, strength, purity and quality.

An FDA-approved generic drug may be substituted for the brand counter when it:

• Contains the same active ingredient(s) as the brand drug;
• Is identical in strength, dosage form and route of administration; and
• Is therapeutically equivalent and can be expected to have the same clinical effect and safety profile.

If your patient’s prescription medication is listed on the Managed Not Covered list, you can:

• Call the FEP Pharmacy Program at 1-800-624-5060 to ask about other covered options.
• Request a formulary exception to our coverage rules by:
  • Visiting www.fepblue.org/pharmacy/prescriptions.
  • Going to the “Covered equivalents for drugs not on our formulary” section at the bottom of the page and selecting the appropriate link.