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Fidelis Care serves more than 1.7 million children and adults of all ages, making us one of the largest health insurance plans in New York State. We were founded on the belief that all New Yorkers should have access to quality, affordable health insurance, and our mission to help others informs everything that we do. 

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Fidelis Care Authorization Grids Effective March 1, 2025
2025/1/29 • Posted by Provider Relations in Provider News

The following codes have been removed from the Medicaid and  Essential Plan Authorization Grids and do not require prior authorization:

J0739 cabotegravir inj 

J0741 cabotegrvir and rilpivirine inj 

J0750 emtricitabine tenofovir df, oral for PReP 

J0751 emtricitabine tenofovir alafenamide, oral for PReP 

J0799 unclassified FDA approved PReP drugs 

J1746 ibalizumab-uiyk (Trogarzo) 

J1961 lenacapavir (Sunlenca) 

Q0521 Pharmacy supplying fee for HIV pre-exposure prophylaxis FDA approved prescription

S0104 zidovudine oral 

S0140 saquinavir oral 

 

Visit:  Authorization Grids

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