Prescription Drug Information

Formulary

• 2022 Formulary
• Notice of Changes
• Formulario 2022

Covered Diabetes Meters and Testing Supplies

• If a drug is not covered in the way you would like it to be covered, you can ask us to make an “exception.” An exception is a type of coverage decision. Similar to other types of coverage decisions, if we turn down your request for an exception, you can appeal our decision. Asking for coverage of a drug that is not on the Prescription Drug Formulary, also called the Drug List, is sometimes called asking for a “formulary exception.” When you ask for an exception, your doctor or other prescriber will need to explain the medical reasons why you need the exception approved. The information can be submitted by phone, fax, mail or electronically. We will then consider your request.

The price of a drug is determined by what “tier” it is on within your formulary. A generic drug may appear on a “preferred tier,” while a brand-name drug may appear on a “non-preferred tier.” Medicine listed on a non-preferred tier may be more expensive than those on a preferred tier. You can reduce how much you pay for prescription drugs by using preferred tier drug. You should talk to your primary care physician about preferred tier options available to you.

Generic Substitution
If Wellcare By Fidelis Care receives a prior authorization or exception request, the medication requested will be generically substituted when an authorized, AB rated equivalent generic is available, unless the request specifically indicates that the brand name is being requested (e.g. Dispense as Written, brand only, etc.), rejections in prescription claims history are for brand, or supporting documentation indicates brand is being prescribed or why generic is not an appropriate treatment option.

Formulary Transition Policy (PDF)

2022

2022 Wellcare By Fidelis Care Medications Requiring Prior Authorization (PDF)

Medication Request Form (PDF)

2022

2022 Fidelis Care Step Therapy Criteria (PDF)

Fidelis Care has contacts with pharmacies that equal or exceed CMS requirements for pharmacy access in your area. There are over 4,400 pharmacies located in New York State that participate in our pharmacy network and over 64,400 network pharmacies nationwide.

• View or download the Fidelis Care Provider and Pharmacy Directory for your county on our Medicare Resources page. 
• To find a pharmacy near you, use the Fidelis Care Find a Doctor tool.
• For our preferred pharmacy list, use the Preferred Pharmacy Look Up tool (by clicking on this link, you will leave the Fidelis Care website).

Visit the CVS Caremark website (by clicking on this link, you will leave the Fidelis Care website) for more information or to register. 

Request for Prescription Drug Coverage Determination

The purpose of this form is to request coverage of a medication that is not on your plan’s drug list or restricted in some way.  

You can submit this form in two ways:  

- Option 1. (Recommended) complete the online form by following the link below. 

- Option 2. Download the PDF hard copy and send to the address at the bottom of this document.

1. Online Form: Medication Request Form

2. Paper Form: Medication Request Form

• Medicare Prescription Drug Denial Request for Redetermination (PDF)
• Medicare Prescription Drug Denial Request for Redetermination Online Form

Medicare Extra Help Program for Prescription Drug Costs

2022 Benefit Parameters Chart

PDF Download: 
2022 Benefit and Payment Parameters

Wellcare By Fidelis Care's premium includes coverage for both medical services and prescription drug coverage.

You can have your medications delivered directly to your home, so you don’t have to make unnecessary trips to the local pharmacy. Not only does this service save you time, it also saves you money. Typically, you can get a 90-day supply of your medication for the price you would pay for two 30-day supplies picked up at the pharmacy counter.

• Learn more about our Mail Order Pharmacy Program.

Mail Order Durable Medical Equipment

For your convenience, Wellcare By Fidelis Care offers direct mail options to fill your durable medical equipment needs. These providers offer a wide range of supplies such as diabetes test strips, bladder control pads, bandages, and more.

• Byram Healthcare. Call 1-877-902-9726, and a customer service representative will assist you with your order. You also can download order forms and fax them to 1-866-811-4500. Online reordering is available at Byram’s website, www.byramhealthcare.com.
• Edgepark Medical Supplies. Call 1-800-321-0591 or visit www.edgepark.com to place an order.

Clicking the links above will cause you to leave the Fidelis Care website