The Fidelis Care Blog

Formulary Changes – Third Quarter 2022 - Medicaid, CHP, and HARP

9/1/2022 • Posted by Provider Relations in Provider News

Fidelis Care has made changes to our Medicaid Managed Care, Child Health Plus (CHP), and HealthierLife (HARP) Formulary. Some of the changes relate to quantity limitations, authorization requirements, as well as drugs being removed and added to the formulary.

Part I: Formulary Additions & PA/ST/QL Removals

Drug/Product	Action	Effective Date
Quetiapine ER	Remove ST	10/01/2022
Donepezil 23mg	Add with QL of #30/30	10/01/2022
Potassium Chloride ER 20EQ Tablet	Add with QL of #240/30	10/01/2022
Omeprazole/Sodium Bicarbonate Rx Capsule	Add with QL of #60/30	08/08/2022