With input from community physicians, specialty societies, and our Pharmacy & Therapeutics Committee, which includes community physicians and pharmacists from across the state, we design programs to help keep prescription drug coverage affordable.
We encourage you to use our medication look-up tools to determine whether prior authorization is required.
If prior authorization is required, you can request it by:
|Phone||Clinical Pharmacy Operations at 1-800-366-7778|
|eForm (Commercial members)||
Submit the appropriate eForm
Hepatitis C medications:
|Fax (Medicare members)||Prior Authorization and Formulary Exception Request Form|
|Call (Federal Employee Program members)||CVS/Caremark at 1-877-727-3784
(available 7 am - 9 pm, Monday through Friday, Eastern Time)
Before administering a medication to a patient in your office or outpatient setting (using the member’s medical benefits), please check to see if the member has medical benefits for this service and determine whether prior authorization is required.
Commercial HMO, POS*, and Access Blue members who have a Massachusetts-based primary care provider must get prior authorization for medications when administered in a clinician’s office or outpatient setting and billed under the member’s medical benefits.
*Blue Choice members using their self-referred benefit do not need to get prior authorization.
Home infusion therapy
Home infusion therapy requires an authorization, regardless of the medication administered.
Medications that aren't covered by medical benefits
These medications are not covered under the member’s medical benefits.
Medical benefits for medications for Federal Employee Program (FEP) members
Check medical policies on fepblue.org to see if an authorization is required for the medication you plan to administer using the member’s medical benefits.