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HomeMemberHelpful ToolsPharmacy Benefit Information

Pharmacy Benefit

Almost all Fidelis Care plans come with a pharmacy benefit. This means your health plan will help pay for your medications. Your medications, when taken as directed, can help keep you healthy.

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Important Information About Medications

There are benefits and risks of medications. It is important to talk to your provider before starting and/or stopping any medications. Here are some questions to ask your healthcare provider before starting a new medication:

    • Why am I taking this medication?
    • Are there any side effects? What should I do if I have a side effect or allergic reaction?
    • How often do I take it?
    • Are there any risks?

Don’t skip doses or change your medication without talking to your provider. Take it just as prescribed, even if you start feeling better or your symptoms go away.

Pharmacy Benefit for Medicaid and HealthierLife Members

NYRx logo

  • Medicaid Managed Care and HealthierLife (HARP) members’ Pharmacy Benefit is managed by NYRx, the New York State Medicaid Pharmacy program.
  • The list of preferred medications under NYRx may differ from that of Fidelis Care. The list of NYRx preferred medications may be found HERE by clicking on 'Preferred Drug List.' The NYRx OTC and Prescription Drug Member Search tool can also provide information about covered medication(s).
  • Questions? Call NY State Medicaid Helpline at 1-800-541-2831 (TTY: 1-800-662-1220) or email NYRx@health.ny.gov.

Pharmacy Benefit for Child Health Plus, Essential Plan, Ambetter from Fidelis Care (QHP), and Wellcare By Fidelis Care (Medicare) Members

Express-Scripts-Image-Logo

What is the Difference Between Generic and Brand Medications?

Generic medications usually cost less than brand-name medications, but provide the same quality of treatment. Generic medications are approved by the FDA. Generic medications work similarly to brand medications. If your provider prescribes a brand medication, you can ask the provider if there is a generic alternative and if it is right for you. Learn more here.

Safe Antibiotic Use

Antibiotics fight bacteria in our bodies when we get sick. Antibiotics only treat infections caused by bacteria, such as strep throat, whooping cough, sepsis, and urinary tract infections. Remember, antibiotics do not work against viruses like the ones that cause the common cold or flu.

Here are some reminders about safely taking antibiotics:

• Do not take antibiotics that are not prescribed for you

• Only take antibiotics exactly as your PCP tells you

• Even if you start to feel better, always finish antibiotics as prescribed by your PCP. Do not skip doses or stop taking them before you run out.

• Don’t share your antibiotics. Don’t save antibiotics for later.

• Talk to your PCP if you have any side effects or reactions. Ask your PCP any questions.

Get Prescriptions Mailed to Your Home

You may qualify for free home delivery of 90-100 day refills. It's offered for certain prescriptions. It's a great way to keep your medications on hand and take them as prescribed.


Do you take medication for a chronic condition? Make sure to take the right dose at the right time and in the right way. Doing so can help you stay healthy and manage your condition.

Talk to your provider about medication mail order. See below for more information about mail order based on your plan.


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Additional Information

Medication Tip Sheets for Members
Asthma Medication Pharmacy Guide

Medication Assisted Therapy Pharmacy Guide

Attention Deficit/Hyperactivity Disorder (ADHD) Pharmacy Guide

Antipsychotic Medication Pharmacy Guide

Antidepressant Medication Pharmacy Guide

Pharmacy Benefits and Services

Pharmacy Benefit for Child Health Plus, Essential Plan, Ambetter from Fidelis Care (QHP), and Wellcare By Fidelis Care (Medicare) Members

Your pharmacy benefits are covered by Express Scripts (by clicking on this link, you will leave the Fidelis Care website). Log in to your Member Portal account to access your pharmacy benefits. Click here for a FAQ to help you learn more about Express Scripts.


Pharmacy Benefit for Medicaid and HealthierLife Members

Medicaid Managed Care and HealthierLife (HARP) members’ Pharmacy Benefit is managed by NYRx, the New York State Medicaid Pharmacy program.  General information about NYRx, the Medicaid Pharmacy Program can be found HERE, along with member information.

Medicare

Benefits include an expanded pharmacy network, including CVS, Walgreens, and many local pharmacies. Depending on your plan, you may also have our Wellcare Spendables Card to use toward the purchase of over-the-counter items and more. Beginning in 2025, you can enroll in the Medicare Prescription Payment Plan to help manage the cost of your Medicare Part D prescriptions. Read your Medicare documents to learn more about your coverage. You can view your Medicare documents at www.fideliscare.org/WellcareMedicare/Medicare-Resources.


Drug Shortage Information

Please refer to the FDA website for the most current and full list of drug shortages. Please refer to the plan-specific formulary for a full comprehensive list of potential alternatives. For NYM/HARP Plans, please refer to the State's Preferred Drug List.
Formularies

A drug formulary is a list of both generic and brand name prescription medications that are covered by your prescription drug benefit. Click your plan below to see the prescription medications that can be prescribed at no extra cost to you.


HealthierLife (HARP) and Medicaid Managed Care (MMC)

Members enrolled in Fidelis Care Medicaid Managed Care and HealthierLife (HARP) plans receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Program.

Qualified Health Plans (Metal-Level Products)

Child Health Plus (CHP)

Essential Plan (EP)

Wellcare By Fidelis Care Medicare and Dual Advantage Plans


2025

2025 Comprehensive Formulary | Wellcare Fidelis Dual Access (Plan 001)

2025 Comprehensive Formulary | Wellcare Fidelis Assist (Plan 002)

2025 Comprehensive Formulary | Wellcare Fidelis Dual Plus (Plan 003)

2025 Comprehensive Formulary | Wellcare Fidelis Simple (Plan 004)


Additional Documents

  • 2025 Covered Diabetes Meters and Testing Supplies
  • 2025 Formulary Transition Policy


    • 2024

    2024 Comprehensive Formulary | Wellcare Fidelis Assist (Plan 002) 

    2024 Comprehensive Formulary | Wellcare Fidelis No Premium (Plan 004) 

    2024 Comprehensive Formulary | Wellcare Fidelis Dual Access & Dual Plus (Plans 001, 003, 008) 



      Additional Plan Documents

      Mail Order Pharmacy Program

      For Essential Plan and Qualified Health Plan Members

      One of the best ways to take care of your health is to take your medications as prescribed. In support of this goal, Fidelis Care offers the Mail Order Pharmacy Program to members enrolled in the Essential Plan and Ambetter from Fidelis Care Qualified Health Plans.

      The Mail Order Pharmacy Program delivers 90-day supplies of your medications to your home at no extra cost to you, without the need for reminder phone calls or trips to the pharmacy. The mail order pharmacy program will be managed by Fidelis Care's pharmacy partner, Express Scripts. The easiest and best way to access your pharmacy benefits is by logging into your Member Portal account. Click here to learn more.


      For Medicare Members

      Fidelis Care’s mail order pharmacy program lets you have up to a 100-day supply of your medications mailed safely to your door. You save time, and in many cases, you save money too. We can even automatically refill and renew your home-delivery prescriptions at no extra cost. Your medications are delivered right to you, saving you trips to the pharmacy and time at the gas pump. Plus, shipping is always free! We even contact your doctor to ask for a 100-day prescription.

      To get started, log into your Member Portal account. Click on Express Scripts from the Member Portal to submit a mail order request.

      Most medications within tiers 1 through 4 of Wellcare By Fidelis Care's Medicare Drug Formulary are eligible for 100-day supply prescriptions. If you need help finding out if your prescriptions are covered in the Wellcare By Fidelis Care Drug Formulary, please call Member Services at 1-800-247-1447 (TTY: 711).

      Speak with your provider to make sure 100-day supply prescriptions are sent to Express Scripts. For more information, please visit our Prescription Drug Information page.

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