Fidelis Care Authorization Grids Effective July 1, 2020
5/28/2020
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Posted by Provider Relations
The following section of the Fidelis Care authorization grids has been updated effective July 1, 2020.
The following services apply to Medicaid, Essential Plan, and Qualified Health Plans (Metal-Level) products and requires prior authorization:
IX. Pharmacy:
B. C9053 crizanlizumab-tmca
J0642 levoleucovorin .5mg (khapzory)
Visit: Authorization Grids