Welcome, Brokers!

As you may know, the United States is experiencing an IV fluid shortage after Hurricane Helene.  Fidelis Care would like to provide guidance regarding prior authorization (PA) requests that may be affected by this shortage.
 

Medications for use in Non-Oncology Diagnoses (PA Requests Submitted Directly to Fidelis Care Pharmacy)

• Fidelis Care is aware of the IV Fluid supply chain issues and has processes in place to consider the impacts of the IV Fluid shortages when reviewing medication Prior Authorization (PA) requests, for as long as the shortage is in effect.
• Providers must include communication and/or documentation that the medication Prior Authorization (PA) request is connected to and/or secondary to the IV Fluid shortage.

Medications for use in Oncology Diagnoses (PA Requests Submitted Directly to Evolent Specialty/NCH)

• Evolent Specialty/NCH is aware of the IV Fluid supply chain issues and has processes in place to consider the impacts of the IV Fluid shortages when reviewing medication Prior Authorization (PA) requests, for as long as the shortage is in effect.

• Evolent Specialty/NCH will consider the IV Fluid shortage when reviewing medication Prior Authorization (PA) requests for non-preferred medications when providers include notation indicating the request’s connections shortage, for as long as the shortage is in effect.
• Providers must include communication and/or documentation that the medication Prior Authorization (PA) request is connected to and/or secondary to the IV Fluid shortage.

Provider Guidance

• When submitting medication PA requests connected to and/or secondary to the IV Fluid shortage, providers should clearly indicate that the medication/medication formulation is requested secondary to the IV bag supply chain issues.
• For any medication PA requests where a provider is requesting a change from an IV medication formulation to a SQ (SC) medication formulation secondary to the IV bag supply chain issues, providers clearly communicate this on their PA submission(s).
  • E.g.) “Changing product/formulation due to IV fluid shortage.”

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

Thank you for being a valued Fidelis Care partner in the provision of quality care.