Pharmacy Services

Express Scripts

Fidelis Care is pleased to announce that, effective January 1, 2024, Express Scripts® began processing pharmacy claims for our plan members.

Providers can direct members to call the Member Services phone number listed on their ID card should they have questions about this change. Alternatively, Fidelis Care has created an Express Scripts FAQ for providers to reference in order to assist members. The FAQ also includes information on mail order services for members that are currently using this method of delivery.

Please note that Acaria remains in network under Express Scripts as an option for your members Specialty Medication needs.

For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Relations Specialist. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist .

NYRx

Effective April 1, 2023, members enrolled in Fidelis Care Medicaid Managed Care and HealthierLife (HARP) plans will receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Program. For more information regarding the pharmacy benefit transition, please visit NYRx, the Medicaid Pharmacy Program. Please note, members will continue to receive their medical benefits through Fidelis Care.

Certain durable medical equipment such as nebulizers, wheelchairs, hospital beds, etc are available under the Fidelis Care medical benefit for these members. For a complete list of covered items, please refer to section 4.4, 4.5, 4.6, and 4.7 in The New York DMEPOS Manual. Please use the Find-A-Doc Tool to locate a Durable Medical Equipment supplier.

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.

Click the categories below for important pharmacy documents and resources.

General Pharmacy Updates

Appropriate Use of GLP-1 Agonists

Authorized Generic vs. "Typical" Generic: What is the Difference?

Duchenne Muscular Dystrophy (DMD) Physician Administered Drug Policies

Genentech Physician Administered Drug Policies

Oncology Statement - American Society of Clinical: Biosimilars in Oncology

What is Biosimilar?

COVID-19 Pharmacy Updates

COVID-19 At-Home Antigen Test Covered Products

COVID-19 Vaccine Counseling Medical Billing Guide for NY Medicaid

COVID-19 Vaccine Pharmacy Billing Guide

COVID-19 Therapeutics Locator Tool

Utilization Management Programs

Opioid Prior Authorization Form (PDF) Effective April 1, 2023, members enrolled in Fidelis Care Medicaid Managed Care and HealthierLife (HARP) plans will receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Program. To initiate a Prior Authorization, please use the following form: https://newyork.fhsc.com/downloads/providers/NYRx_PDP_PA_Fax_Standardized.pdf

Medication Request Form for Medicaid, HARP, CHP, Essential Plans, and Qualified Health Plans (PDF)

Pharmacy Electronic Prior Authorizations Effective April 1, 2023, members enrolled in Fidelis Care Medicaid Managed Care and HealthierLife (HARP) plans will receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Program. To initiate a Prior Authorization, please use the following form: https://newyork.fhsc.com/downloads/providers/NYRx_PDP_PA_Fax_Standardized.pdf

Wellcare By Fidelis Care

Medicare Medication Request Form (PDF)

Medicare Prescription Drug Denial Request for Redetermination (PDF)

Medicare Electronic Drug Coverage Determination Form (Web Resource)

Medicare Prescription Drug Denial Request for Redetermination Online Form (Web Resource)

Medicare Medication Request Form - Medical Benefit (Medicare Part B) (PDF) [This form is to be completed for Wellcare By Fidelis Care Medicare members (including Dual members) for medications to be supplied from the practitioner and/or office stock supply and billed as part of a practitioner service.]

Specialty Drug Program

Acaria Health Specialty Medication Referral Form (PDF)

Accredo Specialty Pharmacy Provider Resources

CVS Caremark Specialty Pharmacy Fax Enrollment Form (PDF)

Care Management Services for Extra Member Support

Evolent Oncology Program

Formularies

HealthierLife (HARP) and Medicaid Managed Care (MMC)

Effective April 1, 2023, members enrolled in Fidelis Care Medicaid Managed Care and HealthierLife (HARP) plans will receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Program.