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Changes to our Federal Employee Program plans for 2024
December 1, 2023

This article is for providers caring for our Federal Employee Program members

Beginning January 1, 2024, we will make changes to our Federal Employee Program (FEP) plans. These plans are offered to federal and postal employees and their families in Massachusetts. Because of these changes, it is important to always check your patient’s Blue Cross ID card and to verify their eligibility and benefits.

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For all FEP plans

We’ll make the following changes to all our FEP plans:

  • New Medicare Prescription Drug Program (MPDP)
    This new pharmacy benefit program allows eligible members with Medicare Part A and/or Part B to get additional approved prescription drugs in some tiers and pay lower out-of-pocket costs for higher-cost drugs. The formularies are available at fepblue.org/medicarerx.
  • Expanded access to mental health care
    We’ll now cover marital and family counseling for all members.

New Benefits

Enhanced reproductive care coverage

Starting January 1, 2024, we’ll cover:

  • Specific artificial insemination procedures.
  • Associated prescription drugs for covered services. Members must receive prior approval for artificial insemination.
  • Up to three annual drug cycles for in vitro fertilization (IVF) for members diagnosed with infertility. Members must receive prior approval and buy prescriptions through our pharmacy programs.

Standard Option members diagnosed with infertility can get any assisted reproductive technology (ART) procedure (not listed as an exclusion in the brochure). We will cover up to $25,000 annually once members receive prior approval.

Gender-affirming care

In 2024, we’ll cover:

  • Breast augmentation for male-to-female gender-affirming care.
  • A mastectomy beginning at the age of 16 for female-to-male gender-affirming care.
  • Certain facial surgeries for gender affirming care and no limit on medically necessary gender-affirming surgical services. Previously, we did not cover facial gender-affirming surgery, and we limited covered procedures to once per lifetime.
  • We’ll only require six months of continuous hormone therapy appropriate to the member’s gender identity, unless medically contraindicated. Previously, we required 12 months of continuous hormone therapy.

Genetic testing

We will cover medically necessary genetic testing for members who may be at high-risk for certain conditions. Members must receive prior approval.

Prior approval changes

The following services will no longer require prior approval:

  • Intensity-modulated radiation therapy (IMRT).
  • Proton beam therapy (for members aged 21 and younger, or when care is related to the treatment of neoplasms of the nervous system including the brain and spinal cord; malignant neoplasms of the thymus; and Hodgkin’s and non-Hodgkin’s lymphomas).
  • Stereotactic radiosurgery (related to the treatment of malignant neoplasms of the brain and of the eye specific to the choroid and ciliary body; benign neoplasms of the cranial nerves, pituitary gland, aortic body, paraganglia; neoplasms of the craniopharyngeal duct and glomus jugular tumors; trigeminal neuralgias, temporal sclerosis, certain epilepsy conditions, or arteriovenous malformations).
  • Surgical treatment for congenital anomalies.

The following medications will require prior approval when covered under the member’s medical benefits:

Therapeutic/Biosimilar Category Product Name HCPCS Codes
AHP (Acute Hepatic Porphyria) Givlaari J0223
Amyloidosis Amvuttra J0225
Amyloidosis Onpattro J0222
Amyloidosis Tegsedi NOC C9399, J3490, J3590
Autoimmune Simponi Aria J1602
Autoimmune Skyrizi J2327
Autoimmune Stelara IV J3358
Autoimmune Stelara SQ J3357
Bevacizumab-maly Alymsys Q5126
Bevacizumab Avastin J9035, C9257
Bevacizumab-awwb Mvasi Q5107
Bevacizumab-adcd Vegzelma Q5129
Bevacizumab-bvzr Zirabev Q5118
Complement Inhibitors Soliris J1300
Complement Inhibitors Ultomiris J1303
Antimyasthenic Agents Vyvgart J9332
Antimyasthenic Agents Vyvgart Hytrulo NOC C9399, J3590
Erythropoietin Procrit/Epogen J0885
Erythropoietin Retacrit Q5106
Filgrastim Neupogen J1442
tbo-Filgrastim Granix J1447
Filgrastim-aafi Nivestym Q5110
Filgrastim-ayow Releuko Q5125
Filgrastim-sndz Zarxio Q5101
Infliximab-axxq Avsola Q5121
Infliximab-dyyb Inflectra Q5103
Infliximab Unbranded Infliximab J1745
Infliximab Ixifi Q5109
Infliximab Remicade J1745
Infliximab-abda Renflexis Q5104
Multiple Sclerosis Ocrevus J2350
Ocular VEGF-aflibercept Eylea J0178
Ocular VEGF - brolucizimab Beovu J0179
Ocular VEGF - faricimab-svoa Vabysmo J2777
Ocular VEGF - ranibizumab-nuna Byooviz Q5124
Ocular VEGF - ranibizumab-eqrn Cimerli Q5128
Ocular VEGF - ranibizumab Lucentis J2778
Hematopoietic - Eflapegrastim Rolvedon J1449
Pegfilgrastim-jmdb, Fulphila Q5108
Pegfilgrastim-pbbk Fylnetra Q5130
Pegfilgrastim Neulasta J2506
Pegfilgrastim Neulasta/Onpro J2506
Pegfilgrastim-apgf Nyvepria Q5122
Pegfilgrastim-fpgk Stimufend Q5127
Pegfilgrastim-cbqv Udenyca Q5111
Pegfilgrastim-bmez Ziextenzo Q5120
Primary Hyperoxaluria Type 1 Oxlumo J0224
Rituximab-arrx Riabni Q5123
Rituximab Rituxan J9312
Rituximab Rituxan Hycela J9311
Rituximab-pvvr, Ruxience Q5119
rituxamab -abbs Truxima Q5115
Trastuzumab Herceptin J9355
Trastuzumab Herceptin Hylecta J9356
Trastuzumab-anns Kanjinti Q5117
Trastuzumab-dkst Ogivri Q5114
Trastuzumab-dttb Ontruzant Q5112
Trastuzumab-dttb Trazimera Q5116

Other important changes

  • Bariatric surgery coverage is now listed in the FEP medical policy.
  • Residential treatment center (RTC)
    We no longer require the member’s written consent to participate in a case management program before they can be admitted for inpatient care provided by an RTC.
  • Stem cell transplants and clinical trials
    FEP has expanded coverage and made changes to clinical trial requirements. Please go to FEPblue.org to review medical policies and Plan specific brochures for specific information.
Changes for Standard or Basic Option Plans

Hearing aids require prior approval for coverage. Previously prior approval was not required.

Changes for Standard Option only

For members who do not have primary Medicare Part A, we no longer require a Skilled Nursing Facility (SNF) signed consent form agreeing to enrollment and active participation in case management during a SNF stay before admission.

Changes for Blue Focus Only
  • Prior approval for kidney transplants will be required.
  • There are no calendar year limitations for stays at RTCs that are medically necessary. Previously, coverage was limited to 30-day inpatient stay per calendar year.

As always, please visit FEPblue.org to review FEP Medical Polices and Plan specific brochures for all-inclusive list of benefits and prior authorization requirements.