Pharmacy Services

Billing Guidance Exceptions for Non-Enrolled Prescribers and Pharmacies

9/19/2022 • Posted by Provider Relations

The New York State (NYS) Medicaid program requires enrollment of all licensed prescribers and pharmacies who serve Medicaid members, including prescribing practitioners identified on pharmacy claims per the Centers for Medicare and Medicaid Services (CMS) and federal regulations. This is applicable to all Fidelis Managed Medicaid members.  Please review the PDF file below for more information:

Billing Guidance Exceptions for Non-Enrolled Prescribers & Pharmacies

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New Century Health Oncology Program

Oncology Services - Medicaid Managed Care and HealthierLife

Oncology Services - Essential Plan and Metal-Level Products (QHP)

Oncology Services - Medicare | Wellcare by Fidelis Care


Medicaid and Healthier Life (HARP) Statewide Medication-Assisted Treatment (MAT) Formulary Update

8/30/2021 • Posted by Provider Relations

The New York State Executive Budget for State Fiscal Year 2020-2021, in accordance to § 367-a (7) (e) of Social Services Law, enacts a statewide formulary for Opioid Antagonists and Opioid Dependence Agents for Medicaid Managed Care (MC) Plans and Medicaid Fee for Service (FFS) Program, starting October 1st 2021. Under this statewide formulary (link provided below), Medicaid MC and FFS members will follow a single formulary, where preferred products and coverage parameters are consistent across the Medicaid Program.

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