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 Quick Reference Guide (PDF)


Metal-Level Products

2019 Formulary (PDF)


Essential Plan

2019 Formulary (PDF)


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

2019 Formulary (PDF)

Prior Authorization (PA) Criteria (PDF)

Step Therapy Criteria (PDF)



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

2019 Formulary (PDF)

Prior Authorization (PA) Criteria (PDF)

Step Therapy 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.