Pharmacy Services

Effective April 1, 2023, members enrolled in Fidelis Care Medicaid Managed Care and HealthierLife (HARP) plans will receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Program. For more information regarding the pharmacy benefit transition, please visit NYRx, the Medicaid Pharmacy Program. Please note, members will continue to receive their medical benefits through Fidelis Care.

Certain durable medical equipment such as nebulizers, wheelchairs, hospital beds, etc are available under the Fidelis Care medical benefit for these members. For a complete list of covered items, please refer to section 4.4, 4.5, 4.6, and 4.7 in The New York DMEPOS Manual. Please use the Find-A-Doc Tool to locate a Durable Medical Equipment supplier.

Formulary Provider Survey:

The Fidelis Care Pharmacy Team is requesting your feedback! In an effort to identify opportunities for improvement, we are asking all providers to participate in a short survey. Please click on this link to share your feedback.

Click the categories below for important pharmacy documents and resources.

General Pharmacy Updates

Authorized Generic vs. "Typical" Generic: What is the Difference?

Billing Medicaid Pharmacy LTC/SNF Claims

Duchenne Muscular Dystrophy (DMD) Physician Administered Drug Policies

Genentech Physician Administered Drug Policies

Oncology Statement - American Society of Clinical: Biosimilars in Oncology

Outpatient Drug Shortage

What is Biosimilar?

COVID-19 Pharmacy Updates

COVID-19 At-Home Antigen Test Covered Products

COVID-19 Oral Antivirals Pharmacy Billing Guide

COVID-19 Vaccine Counseling Medical Billing Guide for NY Medicaid

COVID-19 Vaccine Pharmacy Billing Guide

COVID-19 Vaccine Pharmacy Billing Guide: Booster Doses

COVID-19 Vaccine Pharmacy Billing Guide: Additional Doses for Immunocompromised

COVID-19 Therapeutics Locator Tool

Utilization Management Programs

Opioid Prior Authorization Form (PDF) Effective April 1, 2023, members enrolled in Fidelis Care Medicaid Managed Care and HealthierLife (HARP) plans will receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Program. To initiate a Prior Authorization, please use the following form: https://newyork.fhsc.com/downloads/providers/NYRx_PDP_PA_Fax_Standardized.pdf

Medication Request Form for Medicaid, HARP, CHP, Essential Plans, and Qualified Health Plans (PDF)

Pharmacy Electronic Prior Authorizations Effective April 1, 2023, members enrolled in Fidelis Care Medicaid Managed Care and HealthierLife (HARP) plans will receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Program. To initiate a Prior Authorization, please use the following form: https://newyork.fhsc.com/downloads/providers/NYRx_PDP_PA_Fax_Standardized.pdf

Wellcare By Fidelis Care

Medicare Medication Request Form (PDF)

Medicare Prescription Drug Denial Request for Redetermination (PDF)

Medicare Electronic Drug Coverage Determination Form (Web Resource)

Medicare Prescription Drug Denial Request for Redetermination Online Form (Web Resource)

Specialty Drug Program

Acaria Health Specialty Medication Referral Form (PDF)

CVS Caremark Specialty Pharmacy Fax Enrollment Form (PDF)

Coram Infusion Services - Pegfilgrastim Products Enrollment Form (PDF)

Coram Infusion Services - Infliximab Enrollment Form (PDF)

Care Management Services for Extra Member Support

Evolent Oncology Program (formerly New Century Health)

Formularies

HealthierLife (HARP) and Medicaid Managed Care (MMC)

Effective April 1, 2023, members enrolled in Fidelis Care Medicaid Managed Care and HealthierLife (HARP) plans will receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Program.