Federal Employee Program medical pharmacy prior authorization management

Arkansas Blue Cross and Blue Shield is committed to ensuring that Federal Employee Program (FEP) members receive high-quality health care that is consistent with evidence-based, nationally recognized clinical criteria and guidelines. Accordingly, we are implementing a change in the way we manage prior authorization for FEP members. This new program will be administered by Prime Therapeutics. On February 21, 2022, providers began contacting Prime Therapeutics to obtain prior authorizations for the in-scope drug for FEP members for dates of service on or after March 1, 2022. Providers directly contracted with Arkansas Blue Cross and Blue Shield may create an online account for Prior Authorizations at  Prime Therapeutics Portal. For urgent or expedited requests call Prime Therapeutics at 800-443-5709.

FEP Medical Pharmacy Frequently Asked Questions

Prior Authorization Requests

Providers and their staff will have the opportunity to obtain prior authorizations to help streamline medication administration and service.

• If a prior authorization request does not initially have enough evidence to be approved, it is pended to be clinically reviewed by Prime Therapeutics clinical pharmacists.
• If the initial clinical reviewer finds the request meets clinical criteria, the initial clinical reviewer can approve the prior authorization request.
• If the initial clinical reviewer cannot find enough evidence to approve the request, he/she will schedule a peer-to-peer conversation between the provider and Prime Therapeutics peer clinical reviewer, who is a board-certified physician. The Prime Therapeutics peer clinical reviewer will render the final determination based on the information received.

Note: Prime Therapeutics initial clinical reviewers are clinical pharmacists.