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LATEST NEWS


Formulary Changes – Third Quarter 2023 – Child Health Plus
9/8/2023 • Posted by Provider Relations

Fidelis Care has made changes to our Child Health Plus (CHP) Formulary. Some of the changes relate to quantity limitations, authorization requirements, as well as drugs being removed and added to the formulary.

Part I: Formulary Additions & PA/ST/QL Removals

Drug/Product Action Effective Date
Rykindo Add with PA 10/01/2023
Uzedys Add with PA 10/01/2023

 

Part II: Formulary Removals & PA/ST/QL Additions

Drug Action Formulary Alternatives Effective Date
Hydrocodone-Homatropine Solution Remove from formulary
  • Benzonatate
  • Dextromethorphan Polistirex ext-rel sup
  • Dextromethorphan/Guaifenesin
09/01/2023
Promethazine-Phenylephrine-Codeine Syrup Remove from formulary
  • Benzonatate
  • Dextromethorphan Polistirex ext-rel sup
  • Dextromethorphan/Guaifenesin
09/01/2023
Promethazine- Dextromethorphan Syrup Remove from formulary
  • Benzonatate
  • Dextromethorphan Polistirex ext-rel sup
  • Dextromethorphan/Guaifenesin
09/01/2023
Pseudoephedrine- Brompheniramine - Dextromethorphan Syrup Remove from formulary
  • Benzonatate
  • Dextromethorphan Polistirex ext-rel sup
  • Dextromethorphan/Guaifenesin
09/01/2023
Ammonium Lactate Remove from formulary N/A 10/01/2023
Urea Remove from formulary N/A 10/01/2023

 


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