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Obtaining Pharmacy Specialty Medications Update
5/7/2019 • Posted by Provider Relations

*Attention Specialty Medication Prescribers *
This notice is to provide information regarding specialty medications.  Members can obtain covered specialty drugs at any retail pharmacy in Fidelis Care’s network, as long as that retail network pharmacy accepts Fidelis Care’s specialty network terms and conditions.  If your patient has difficulty obtaining this medication from his or her preferred network pharmacy, AcariaHealth, a specialty pharmacy participating in Fidelis Care’s specialty network, can assist you with filling the prescription.  You will also be able to “buy and bill” specialty medications via AcariaHealth (Phone: 1-800-511-5144; Fax: 1-877-541-1503).  An additional specialty pharmacy in the Fidelis Care network that offers these services is CVS Specialty (Phone: 1-800-238-7828; Fax: 1-800-567-8000).  

To refer your patient for home infusion services, specifically to set up a nurse to infuse Pegfilgrastim or Infliximab, you may contact Coram Infusion Services (Phone: 1-800-522-0556).  Please complete the Specialty Pharmacy Services Enrollment Form.  The completed form may be faxed to 1-800-880-9022.  

To view the enrollment forms on our website, visit Specialty Drug Program.
 

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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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