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2019 Fidelis Care Formulary Changes
3/8/2019 • Posted by Provider Relations

Fidelis Care has made changes to our Medicaid Managed Care/Child Health Plus/HealthierLife; Metal Level; and Essential Plan Formularies. Some of the changes relate to quantity limitations, authorization requirements, as well as drugs being removed and added to the formulary. Impacted members and providers have been notified of the upcoming changes.

To review the list of changes and the effective dates, please download:

Child Health Plus (CHP), HealthierLife (HARP), and Medicaid Managed Care
     • 2019 Formulary Changes
Metal-Level Products
     • 2019 Formulary Changes
Essential Plan
     • 2019 Formulary Change

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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. 

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