9/29/2025
• Posted by Provider Relations
Fidelis Care’s Pharmacy Services would like to provide clarification on how medications are covered under member’s medical and pharmacy benefits.
Medications Covered Under Fidelis Care Medical Benefit
Physician Administered Drugs – medications administered to a member during an outpatient visit
Providers obtain medication via “buy-and-bill” or shipment to their practice site from a vendor of their choosing.
Coverage is dictated by Fidelis Care Authorization Grids, Prior Authorization Lookup Tool and/or Evolent Specialty Services (formerly NCH) Authorization Grids (Oncology Regimen Specific).
Medical Benefit Authorization Grids are plan specific.
If a medication is listed on one of the above authorization grids/tools, an authorization
9/26/2025
• Posted by Provider Relations
Fidelis Care will host three Provider Office Hours in October 2025. During the webinars, Fidelis Care staff will be available to share information, provide an overview of provider resources, and answer your questions.
Provider Office Hours – October 2025
Topic: Fidelis Care Tools & Resources Overview
When: Thursday, October 9th – 12PM – 1PM EST
Click here to register*
Topic: Fidelis Care and Wellcare - Quality Programs
When: Wednesday, October 15th – 10 AM – 11 AM EST
9/17/2025
• Posted by Provider Relations
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:
9/10/2025
• Posted by Fidelis Care
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.
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