Pharmacy Services

Click the categories below for important pharmacy documents and resources. 

Formularies

Child Health Plus (CHP), HealthierLife (HARP), and Medicaid Managed Care

2019 Drug Formulary (PDF)

2019 Formulary Changes (PDF)

2019 Formulary Quick Reference Guide (PDF)

2018 Formulary (PDF)

Quick reference list (PDF)


Metal-Level Products

2019 Formulary (PDF)

2019 Formulary Changes (PDF)

2018 Formulary (PDF)

2017 Formulary (PDF)


Essential Plan

2019 Formulary (PDF)

2019 Formulary Changes (PDF)

2018 Formulary (PDF)

2017 Formulary (PDF)


Fidelis Dual Advantage, Fidelis Medicaid Advantage Plus and Fidelis Dual Advantage Flex 

2019 Formulary (PDF)

2019 Formulary Changes (PDF)

Prior Authorization (PA) Criteria (PDF)

Step Therapy Criteria (PDF)


2018 Formulary (PDF)

Prior Authorization (PA) Criteria (PDF)


Fidelis Medicare Advantage Flex (HMO POS) and Fidelis Medicare $0 Premium (HMO)

2019 Formulary (PDF)

2019 Formulary Changes (PDF)

Prior Authorization (PA) Criteria (PDF)

Step Therapy Criteria (PDF)


2018 Formulary (PDF)

Prior Authorization (PA) Criteria (PDF)



Provider Access Online

Verify member eligibility, check claims status, and more.

Manuals and Forms

Provider manuals, tip sheets, important forms, and applications. 

Authorization Grids

Authorization Grids for Medicare, Medicaid, Child Health Plus, and NY State of Health Marketplace plans.