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Important Medicare Part D Formulary Changes for the 2019 Plan Year
12/6/2018 • Posted by Provider Relations

On January 1, 2019, the Medicare Preferred Drugs list will change.  To ease the transition, impacted members and providers have been notified of the upcoming changes.  The preferred drug lists for 2019 and a comprehensive list of comparable, alternative drugs can be found here: https://www.fideliscare.org/Provider/Provider-Resources/Pharmacy-Services

Please review the formulary alternative(s) with your patients and determine if it is appropriate for his or her condition.  If for any reason you feel the suggested alternative is not appropriate, you may request a formulary exception by completing and submitting the form available at: https://www.fideliscare.org/apps/DrugDetermination/

Thank you for your help with transitioning members to comparable alternatives.

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Important Information on Coverage Decisions

Each day, Fidelis Care's Utilization Management (UM) Department makes decisions on numerous health insurance claims. These decisions are based only on appropriateness of care and the existence of coverage. 

Fidelis Care does not reward practitioners or other individuals for issuing denials of coverage, and does not offer financial incentives to UM staff that would encourage decisions that result in underutilization of services. 

Fidelis Care is committed to ensuring that members have the care and services they need. 

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