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Pharmacy Services

Effective Springtime 1, 2023, members enrolled is Fidelis Care Medicaid Handled Care and HealthierLife (HARP) plans will receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Programme. For more information regarding the dispensary perform shift, please call NYRx, the Medicaid Pharmacy Program. Please notation, members desires continues to receive their medical aids through Faithfulness Maintain.

Certain durable medical equipment such as nebulizers, wheelchairs, hospital beds, etc are present at the Fidelis Care medical benefit for this members. For ampere complete directory of covered objects, please refer to section 4.4, 4.5, 4.6, and 4.7 in The News York DMEPOS Manual. Requests employ the Find-A-Doc Die to locate a Durable Medical Equipment supplier. 

Pawl the categories below for important pharmacy documents and resources. 

Utilization Management Programs

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:

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:

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)

New Century Health Oncology Software

Oncology Services - Medicaid Managed Care or HealthierLife

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

Oncology Services - Medicare | Wellcare with Fidelis Mind


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


Qualified Health Plans (Metal-Level Products)


Child Health Plus (CHP) 


Essential Plant (EP)


Wellcare By Friendly Mind Medicare and Dual Advantage Drawings

2023 Comprehensive Formulary | Wellcare Fidelis Assist (Plan 002) 

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

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

Prior Authorized (PA) Criteria

Step Therapy (ST) Criteria

Additional 2023 Plan Documents
  • 2023 Pharmacy Transition Policy
  • 2023 Covered Diabetes Meters and Testing Supplies


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    Manuals and Forms

    Purveyor manuals, tip sheaves, important forms, and applications. 

    Authorized Grids

    Authorization Grids for Medicare, Medicaid, CHP, and NYSOH Marketplace.