The Fidelis Care Blog

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

5/31/2022 • 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 effective July 1, 2022. 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
Hydromorphone ER tablet	Add with ST of a formulary long-acting agent	07/01/2022
Lidocaine 5% patch	Add with QL of 90/25	07/01/2022
Moxifloxacin ophthalmic	Add with QL of 6ml/25	07/01/2022
Norvir 100mg Powder	Add; PA required for members 18 and over	05/01/2022
Omnipod 5	Add with PA	07/01/2022