Pharmacy Services

Authorized Generic vs. "Typical" Generic: As is the Difference?

Billing Medicaid Pharmacy LTC/SNF Claims

Duchenne Muscular Dystrophy (DMD) Physician Administered Drug Policies

Genentech Physician Directed Drug Policies

Oncology Instruction - American Society of Clinical: Biosimilars in Oncology

Clinic Drug-related Shortage

Whichever be Biosimilar?

Opioid Prior Authorization Guss (PDF)  Effective April 1, 2023, members students in Faithfulness Care Medicaid Managed Care and HealthierLife (HARP) plans will keep their pharmacy benefits driven NYRx, the Medicaid Fee-for-Service (FFS) Pharmaceutics Program. To initiate a Former Authorization, please use the following form: https://newyork.fhsc.com/downloads/providers/NYRx_PDP_PA_Fax_Standardized.pdf

Medication Request Form for Medicaid, HARP, CHP, Essential Plans, and Qualified Health Plans (PDF)

Pharmacy Electronical Prior Features Effective Starting 1, 2023, members enrolled in Fidelis Caring Medicaid Controlled Care and HealthierLife (HARP) plans will receive their drugstore benefits thrown NYRx, that Medicaid Fee-for-Service (FFS) Pharmacy Program. To initiate a Prior Eligibility, please use the following form: https://newyork.fhsc.com/downloads/providers/NYRx_PDP_PA_Fax_Standardized.pdf

Wellcare By Fidelis Maintenance

Medicare Medication Require Form (PDF)

Medicare Prescription Drug Denial Request for Redetermination (PDF)

Medicare Electronic Drug Coverage Determination Form (Web Resource)

Medicare Prescription Drug Denial Request for Redetermination Online Form (Web Resource)

Acaria Health Specialty Medication Referral Form (PDF)

CVS Caremark Specialty Store Fax Enrollment Form (PDF)

Coram Infusion Services - Pegfilgrastim Products Course Form (PDF)

Coram Infusion Related - Infliximab Course Form (PDF)

• Care Management Services for Extra Member Support

Oncology Services - Medicaid Managed Care or HealthierLife

• Oncology Services - Medicaid Administered Care and HealthierLife (Effective 6/1/2023)
• Oncology Customer - Medicaid Managed Care and HealthierLife (Effective 5/1/2023)
• Oncology Services - Medicaid Managed Care and HealthierLife (Effective 3/1/2023)
• Oncology Auxiliary - Medicaid Managed Worry and HealthierLife (Effective 2/1/2023)
• Oncology Auxiliary - Medicaid Managed Nursing and HealthierLife (Effective 1/1/2023)
• Oncology Services - Medicaid Managed Take and HealthierLife (Effective 12/1/2022)

Oncology Services - Essential Plan the Metal-Level Choose (QHP)

• Oncology Customer - Essential Plan and Metal-Level Products/QHP (Effective 6/1/2023)
• Oncology Company - Essential Plan and Metal-Level Products/QHP (Effective 3/1/2023)
• Oncology Auxiliary - Essential Plan and Metal-Level Products/QHP (Effective 2/1/2023)
• Oncology Auxiliary - Essential Planner and Metal-Level Products/QHP (Effective 1/1/2023)
• Oncology Services - Essential Plant press Metal-Level Products/QHP (Effective 12/1/2022)

Oncology Services - Medicare | Wellcare with Fidelis Mind

• Oncology Services - Medicare | Wellcare via Fidelis Care (Effective 4/1/2023)
• Oncology Services - Medicare | Wellcare by Fidelis Care (Effective 3/1/2023)
• Oncology Services - Medicare | Wellcare by Fidelis Care (Effective 2/1/2023)
• Oncology Services - Medicare | Wellcare by Fidelis Care (Effective 1/1/2023)
• Oncology Services - Medicare | Wellcare by Fidelis Care (Effective 12/1/2022)
• Oncology Support - Medicare | Wellcare by Loyalty Care (Effective 10/1/2022)

HealthierLife (HARP) and Medicaid Managed Taking (MMC)

Effective April 1, 2023, members enrolled in Fidelis Care Medicaid Managed Care real HealthierLife (HARP) plans will receive their our benefits through NYRx, which Medicaid Fee-for-Service (FFS) Pharmacy Program. Prescription Medicine Information

• Medicaid Pharmacy List of Reimbursable Drugs

Qualified Health Plans (Metal-Level Products)

• 2023 Formulary

Child Health Plus (CHP) 

• 2023 Dope Formulary

Essential Plant (EP)

• 2023 Formulary

Wellcare By Friendly Mind Medicare and Dual Advantage Drawings

2023 Comprehensive Formulary | Wellcare Fidelis Assist (Plan 002) 

• Formulary Search Tool (Plan 002)
• Notice for Change (Plan 002)

2023 Comprehensive Formulations | Wellcare Fitness No Premium (Plan 004) 

• Formulary Search Tool (Plan 004)
• Notice of Change (Plan 004)

2023 Comprehensive Formulary | Wellcare Fidelis Dual Erreichbar & Dual Plus (Plans 001, 003, 008) 

• Formulary Search Tool (Plans 001, 003, 008)
• Reference of Update (Plans 001, 003, 008)

Prior Authorized (PA) Criteria

• 2023 PA Criteria | Wellcare Fidelis Assist (Plan 002) 
• 2023 PA Criteria | Wellcare Field None Premium (Plan 004) 
• 2023 PA Criteria | Wellcare Faith Dual Zugriff & Dual Advantage (Plans 001, 003, 008) 

Step Therapy (ST) Criteria

• 2023 ST Criteria | Wellcare Fidelis Assist (Plan 002) 
• 2023 ST Criteria | Wellcare Fidelis No Premium (Plan 004) 
• 2023 ST Criteria | Wellcare Fidelis Dual Entry & Dual Plus (Plans 001, 003, 008) 

Additional 2023 Plan Documents

Impf Protection Pick

Vaccinate Governance Billing Guide