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Pharmacy Benefit Carve Out Update
5/24/2023 • Posted by Provider Relations

Fidelis Care’s pharmacy benefit for Medicaid Managed Care and HARP was transitioned to NYRx, the New York State Medicaid Pharmacy program on April 1, 2023.

Fidelis Care wants to make you aware that the list of preferred medications under NYRx may differ from Fidelis Care and may require prior authorization. A list of common Fidelis Care preferred medications that may require a prior authorization under NYRx may be found here: Medicaid and Healthier Life Potentially Impacted Medications.

The list of NYRx preferred medications may be found on the Magellan website. (https://newyork.fhsc.com)

If it has been determined that a prior authorization is required for continuity of care, prescribers may contact Magellan's Clinical Call Center at 1-877-309-9493 or fax 1-800-268-2990. The clinical call center is available 24 hours a day, 7 days per week.

Medicaid enrolled prescribers can initiate prior authorization (PA) requests using a web-based application, PAXpress® (https://paxpress.nypa.hidinc.com/)

*Please note: Prior authorization requests through PAXpress® that do not meet clinical criteria will require that prescribers call Magellan Medicaid Administration.

 

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