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Click the categories below for important pharmacy documents and resources.
Pharmacy Network Changes (Effective January 1, 2021)
COVID-19 Testing: Pharmacy Billing Guide (PDF)
COVID-19 Vaccine Pharmacy Billing Guide (PDF)
Pharmacy Prior Authorization Process Effective June 1, 2020 (PDF)
Billing Medicaid Pharmacy LTC/SNF Claims (PDF)
Pharmacy Vaccine Coverage and Billing Guide for Medicaid, CHP and HARP (PDF)
Requesting Synagis for Fidelis Care Members (PDF)
Authorized Generic vs. "Typical" Generic: What is the Difference? (PDF)
What is Biosimilar? (PDF)
American Society of Clinical Oncology Statement: Biosimilars in Oncology (PDF)
2021 Drug Formulary (PDF)
2021 Formulary Quick Reference Guide (PDF)
2021 Formulary (PDF)
2020 Formulary (PDF)
Changes to Fidelis Care’s Medicare Formulary (PDF)
2021 Step Therapy Criteria (PDF)
2021 Prior Authorization (PA) Criteria (PDF)
2020 Step Therapy Criteria (PDF)
2020 Prior Authorization (PA) Criteria (PDF)
Pharmacy Electronic Prior Authorizations
Medication Request Form for Medicaid, CHP, Essential Plans and Qualified Health Plans (PDF)
Opioid Prior Authorization Form (PDF)
Hepatitis C Prior Authorization Form (PDF)
HIV Prior Authorization Form (PDF)
Medicare Medication Request Form (PDF)
Medicare Medication Request Form - Spanish (PDF)
Medicare Electronic Drug Coverage Determination Form (PDF)
Medicare Prescription Drug Denial Request for Redetermination (PDF)
Medicare Prescription Drug Denial Request for Redetermination Online Form
New York State Department of Health standardized prior authorization form (PDF)
Request for an Alternative Contraceptive, Drug, Device, or Product (PDF)
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)
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Provider manuals, tip sheets, important forms, and applications.