Bienvenidos, Corredores!

The following sections of the Fidelis Care authorization grids have been updated effective October 1, 2025.             The following codes have been updated on the Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare Authorization Grids and require prior authorization: C9305      nipocalimab-aahu (Imaavy) C9306      telisotuzumab vedotin-tllv (Emrelis) J0614      treosulfan (Grafapex) J1370      esomeprazole injection J1809      fosdenopterin J3402      remestemcel-l-rknd (Ryoncil) J3403      Revakinagene taroretcel-lwey (Encelto) J7173      concizumab-mtci (Alhemo) J7174      fitusiran (Qflitlia) J9011      datopotamab deruxtecan-dlnk (Datroway) Q5154     omalizumab-igec (Omlyclo) Q5155     aflibercept-jbvf (Yesafili) Q5156     tocilizumab-anoh (Avtozma) Q5157     denosumab-bmwo (Stoboclo/Osenvelt) Q5158     denosumab-bnht (Bomyntra/Conexxence) Q5159     denosumab-dssb (Ospomyv/Xbryk)   For Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare, the following codes have been added to the list of drugs that require NCH review: J9011      datopotamab deruxtecan-dlnk (Datroway) Q5156     tocilizumab-anoh (Avtozma) Q5157     denosumab-bmwo (Stoboclo/Osenvelt) Q5158     denosumab-bnht (Bomyntra/Conexxence) Q5159     denosumab-dssb (Ospomyv/Xbryk)   Visit: 

El objetivo de las subvenciones es respaldar los programas de atención preventiva innovadora en comunidades rurales LONG ISLAND CITY, NY (10 de septiembre de 2025) Fidelis Care, un plan de salud estatal con más de 2.4 millones de miembros en el estado de Nueva York y propiedad de la empresa Centene Corporation, abrió el proceso de presentación de solicitudes para su programa de subvenciones de salud rural de 2025.

Fidelis Care would like to inform providers of a significant development impacting COVID-19 vaccine access across New York State. On Friday, Governor Kathy Hochul signed an executive order declaring a disaster emergency to ensure near-universal access to the latest COVID-19 vaccines. This order, effective through October 5, 2025, enables pharmacists to prescribe and administer the 2025–2026 COVID-19 vaccine formulations to patients ages 3 and older. While the FDA has only approved the latest vaccine formulations for individuals at high risk of severe illness or those aged 65 and older, the executive order allows broader access in anticipation of the upcoming respiratory virus season. Key Points

Fidelis Care is pleased to announce that a new Provider Bulletin is now available. The bulletin features updates on important initiatives and the latest news of interest to our provider community. Articles in this issue: ·         Championing Mental Health: Early Intervention is Key ·         Important Reminders About HIV Prevention and Testing ·         Supporting Maternal Health for Healthy Pregnancies and Babies ·         Encourage Preventive Cancer Screenings ·         Help Your Patients of All Ages Stay Active! ·         Access and Availability Standards   Please download Fidelis Care Provider Bulletin – Volume 11, Issue 3.   To view our Provider Bulletin Library, please visit: Provider Bulletins.

As part of an ongoing series, Fidelis Care will highlight some best practices we learn from our partners across the State in the interest of providing the best experience possible for our members. For this month’s highlight, we’re looking at the Teach-Back Method, a communication technique where providers ask patients to repeat back key information in their own words. This helps confirm understanding, identify confusion, and reinforce learning—especially around diagnoses, medications, and follow-up care.   How It Works After explaining a concept or instruction, you may want to say: “I want to make sure I explained this clearly. Can you tell me how you’ll manage