fidelis ny medicaid formulary 2023

We're here to help! Find information and links to external vendor authorizations and to internal resources. Medicaid Pharmacy Program (NYRx) - New York State Department of Health No need to wait for open enrollment: You can enroll in Medicaid Managed Care year-round. This guidance provides information in addition to what was provided in the October 2022 NYRx Pharmacy Benefit Transition - Part One Special Edition issue of the Medicaid Update. NYS DOH analyzed PADs that were provided as a Pharmacy Benefit through MMC Plans. Exceptions to the prescriber enrollment requirements for certain authorized prescribers are outlined in the Reminder: Pharmacy Billing Guidance Exceptions for Non-Enrolled Prescribers article published in the June 2022 issue of the Medicaid Update. NYRx Transition Fill Period is Ending as of June 30, 2023 | Fidelis Care FIDELIS and FIDELIS CARE are trademarks of Centene Corporation, NY State of Health, the Official Health Plan Marketplace, Transparency in Coverage Machine Readable Files, Dental and vision coverage options for the entire family*, Preventive services and chronic disease management, Mental health and substance use disorder services, Wellness and Silver One options that include acupuncture**. Medicaid Free or low-cost coverage from one of the top-rated plans in New York State. Apply to our network andbecome apart of the Fidelis Care mission. Pharmacy Services - Fidelis Care Effective April 1, 2023, members enrolled in Fidelis Care Medicaid Managed Care and HealthierLife (HARP) plans will receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Program. Providers - Fidelis Care Find a Fidelis Care office near you. Brand name drug: Uppercase in bold type Generic drug: Lowercase in plain type AL: Age Limit Restrictions DO: Dose Optimization Program GR: Gender Restriction The pharmacy benefit transition to NYRx does not apply to NYS Medicaid members enrolled in Managed Long-Term Care (MLTC) Plans [e.g., MLTC, Programs of All-Inclusive Care for the Elderly (PACE), Medicaid Advantage Plus (MAP)], the Essential Plan (EP), or Child Health Plus (CHP). View and download New York State health plan materials, provided by health insurance company, Fidelis Care. . If you are interested in receiving MRT email alerts, visit the MRT LISTSERV web page to subscribe. James McDonald, M.D., M.P.H.Acting CommissionerNew York State Department of Health, Amir BassiriMedicaid DirectorOffice of Health Insurance Programs, New York State Medicaid Update - January 2023 NYRx Pharmacy Benefit Transition Part Two: Special Edition Volume 39 - Number 1, Health & Safety in the Home, Workplace & Outdoors, Clinical Guidelines, Standards & Quality of Care, All Health Care Professionals & Patient Safety, January 2023 DOH Medicaid Updates - Volume 39, Information for All Providers (Including Pharmacies), New York State Medicaid Managed Care (MMC) Pharmacy Benefit Information Center website, ePACES - MEVS Eligibility Request instructional document, NYS DOH "COVID-19 Guidance for Medicaid Providers - Coverage and Billing Guidance" web page, Magellan Health, Inc. Rx Management, LLC "Preferred Diabetic Supply Program" web page, Magellan Health, Inc. Rx Management, LLC "Brand Less Than Generic Program" web page, eMedNY "Medicaid Pharmacy List of Reimbursable Drugs" web page, NYS DOH "Medicaid Enrolled Provider Lookup" web page, eMedNY "Medicaid Managed Care Network Provider Enrollment" web page, eMedNY "Provider Enrollment and Maintenance" web page, eMedNY "Provider Enrollment and Maintenance" web page for DME, New York State (NYS) Department of Health (DOH) Office of Health Insurance Programs (OHIP) NCPDP D.0 Standard Companion Guide - Transaction Information, NYRx Medicaid Prior Authorization Request Form for Prescriptions, Magellan Health, Inc. NYRx, the Medicaid Pharmacy Program, Magellan Health, Inc. NYRx, the Medicaid Pharmacy Program Preferred Drug List (PDL) Listserv email notification sign-up, NYRx, the Medicaid Pharmacy Program, Preferred Diabetic Supply Program, NYS DOH Transition of the Pharmacy Benefit from Managed Care (MC) to the Medicaid Pharmacy program, NYRx Frequently Asked Questions (FAQs), NYS Programs MEVS Instructions for Completing a Telephone Transaction, Magellan Health, Inc. NYS Medicaid Pharmacy Program, eMedNY's Medicaid Pharmacy List of Reimbursable Drugs, eMedNY's Provider Enrollment and Maintenance, James V. McDonald, M.D., M.P.H., Commissioner, The Latest on New York's Response to COVID-19, Multisystem Inflammatory Syndrome in Children (MIS-C), Health Care and Mental Hygiene Worker Bonus Program, Lyme Disease & Other Diseases Carried By Ticks, Maternal Mortality & Disparate Racial Outcomes, NY State of Health (Health Plan Marketplace), Help Increasing the Text Size in Your Web Browser, electronic Provider Assisted Claim Entry System (ePACES), Not enrolled (MCO Credentialed as a non-billing provider), Enroll with NYS Medicaid as a billing provider, Enroll with NYS Medicaid as a billing or an OPRA provider, Ordering, Prescribing, Referring, Attending (OPRA), Enrolled (Qualified non-billing provider), Enroll with NYS Medicaid as billing provider or if eligible as a OPRA provider, Claims Processing for Outpatient Pharmacy Benefits. reimbursable by New York State Medicaid. Preferred Diabetic Supply List (PDSL), etc. The Client Identification Number or CIN is a unique number assigned to each NYS Medicaid member. Physician DispensersFor the current NYRx policy regarding physician dispensers, providers can refer to the Policy Clarification for Practitioner Dispensing article in the July 2022 issue of the Medicaid Update. NYS Medicaid recognizes the authority under which these unlicensed providers may prescribe; however, per federal requirements, these physicians are not eligible for enrollment into the NYS Medicaid program without a license. Once youknow the health coverage you qualify for, there are four ways you can enroll: Tell us more about yourself to find qualifying plans and estimate costs. Effective April 1, 2023, Medicaid members enrolled in Fidelis Care Managed Care Plans, Health and Recovery Plans (HARPs), and HIV-Special Needs Plan (SNPs) will begin to receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Program. To assist our providers, we have included the list below of the most commonly prescribed drugs being removed along with the drugs 2022 formulary alternative(s). 2023 Covered Diabetes Meters and Testing Supplies 2023 Formulary Transition Policy 2022 2022 Comprehensive Formulary . All Rights Reserved | Capital District Physicians' Health Plan, Inc. | 500 Patroon Creek Blvd. Contact with and (suspected) exposure to COVID-19, AstraZeneca Tixagev and Cilgav Injection, AstraZeneca Tixagev and Cilgav Injection, Eli Lily Monoclonal - Bamlan/Etesev Injection, Eli Lily Monoclonal - Bamlan/Etesev Infusion, GSK Monoclonal - Sotrov Infusion In Home, Genentech Monoclonal - Tocili 1st Infusion, Genentech Monoclonal - Tocili 2nd Infusion, Regeneron Monoclonal - Casiri/Imdev Injection, Regeneron Monoclonal - Casiri/Imdev Infusion, Regeneron Monoclonal - Casiri/Imdev Injection, Regeneron Monoclonal - Casiri/Imdev Injection, Regeneron Monoclonal - Casiri/Imdev Infusion, Pfizer Vaccine (Pediatric) Admin - 1st Dose, Pfizer Vaccine (Pediatric) Admin - 2nd Dose, NEW - SARS-COV2 Vaccine, mRNA-LNP 10MCG/0.2mL for 5 - 11 years - Booster, Pfizer Vaccine (Ready to use) Admin - 1st Dose, Pfizer Vaccine (Ready to use) Admin - 2nd Dose, Pfizer Vaccine (Ready to use) Admin - 3rd Dose, Pfizer Vaccine (Ready to use) Admin Booster, Administration - Moderna COVID-19 Vaccine 50MCG/0.5ML Booster, Administration - SARS-COV2 Vaccine, mRNA-LNP 3MCG/0.2mL for 6 months 5 years 1st Dose, Administration - SARS-COV2 Vaccine, mRNA-LNP 3MCG/0.2mL for 6 months 5 years 2nd Dose, SARS-COV2 Vaccine, mRNA-LNP 3MCG/0.2mL for 6 months 5 years. If the MRA and ALT fields are equal, the ALT field will be set to zeroes. Providers may review the Medicaid Pharmacy List of Reimbursable Drugs for products covered. Beginning April 1, 2023, all members enrolled in CDPHP Medicaid will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program. Highly March 1, 2023, associates enrolled in Fidelis Care Medicaid Managed Care and HealthierLife (HARP) plans will receive their chemist features through NYRx, this Medicaid Fee-for-Service (FFS) Pharmacy Program. Covered Drugs, Preferred Drugs and Covered Supplies in the NY Medicaid Pharmacy Program (Medicaid FFS), Health & Safety in the Home, Workplace & Outdoors, Clinical Guidelines, Standards & Quality of Care, All Health Care Professionals & Patient Safety, James V. McDonald, M.D., M.P.H., Commissioner, The Latest on New York's Response to COVID-19, Multisystem Inflammatory Syndrome in Children (MIS-C), Health Care and Mental Hygiene Worker Bonus Program, Lyme Disease & Other Diseases Carried By Ticks, Maternal Mortality & Disparate Racial Outcomes, NY State of Health (Health Plan Marketplace), Help Increasing the Text Size in Your Web Browser, The NY Medicaid Pharmacy Program (FFS) has a list of covered drugs, which include over-the-counter drugs. Medicaid Drug Coverage | CDPHP - CDPHP These prescribers need to be either enrolled in Medicare with an "approved" status or enrolled in their own state's Medicaid program. Authorization Grids are now available for Medicare, Medicaid, Child Health Plus, andNY State of Health Marketplace plans,and are effective for dates of service occurring on or after the dates below. Access the Provider Attestation Statement and submit completion of training. Each MMC Plan will implement point-of-service claim denial messaging that directs pharmacies to bill NYRx where applicable. Check out our available positions. Fidelis Care Qualified Health Plan Products are standardized plans offered by Fidelis Care via NY State of Health, the Official Health Plan Marketplace. Visit the, A list of preferred diabetic meters and test strips. Dexilant, Oseni, Protonix suspension, Pylera, Vascepa and Viibryd will be ADDED to the program; Click Here to Read More NYS DOH will allow a one-time transition fill from April 1, 2023, through June 30, 2023, for non-preferred diabetic supplies that are not part of the PDSP and will honor PAs already provided by the MMC Plans. Pharmacy claims will initially reject for NCPDP Reject Code ", In Field 439-E4 (Reason for Service Code): enter, In Field 441-E6 (Result of Service Code): enter applicable value (, In Field 420-DK (Submission Clarification Code): enter, All questions regarding this update should be directed to the Medicaid Pharmacy Policy Unit by telephone at (518) 486-3209 or by email at. 2023 MVP Marketplace Formulary (PDF) Applies to individuals who purchase their health plan on their own from NY State of Health, The Official Health Plan Marketplaceincluding the Essential Planor Vermont Health Connect or who purchase the plan directly from MVP. Health insurance will no longer be automatically renewed for Medicaid Managed Care, Essential Plan, Child Health Plus, or HealthierLife members. Plans fall into various "metal" levels based on their design and the level of cost sharing required: Platinum, Gold, Silver, Bronze, and Catastrophic Coverage. Please see the full list here. On December 22, 2021, Governor Hochul signed Chapter 720 of the Laws of 2021. 6/29/2023 Posted by Provider Relations. In a future update, NYS Department of Health (DOH) will provide the claim denial messaging that will be used by MMC Plans, starting April 1, 2023. Prescription Drug Information - Fidelis Care The full list of reimbursable drugs may be viewed online or downloaded, using the link provided below. eMedNY : Provider Manuals : Physician Qualified Health Plans - Fidelis Care NYRx, the Medicaid Pharmacy Program | Preferred Diabetic Supply Program Registration information will be posted one week prior to each webinar date. Specific details can be found in the October 2022 NYRx Pharmacy Benefit Transition - Part One Special Edition issue of the Medicaid Update. NYS Medicaid members may also contact the NYS Medicaid Consumer Helpline by calling (800) 541-2831 to obtain their CIN. These requirements ensure proper storage and handling. ** Change for NYM/HARP Only; Change will not affect CHP, * Change for CHP Only; Change will not affect NYM/HARP Drug List (Formulary) | Wellcare Beginning April 1, 2023, Medicaid members enrolled in mainstream Managed Care (MC) plans, Health and Recovery Plans (HARPs), and HIV-Special Needs Plans (SNPs) will have their pharmacy benefits transitioned to NYRx, the Medicaid Pharmacy program. Provider National Provider Identifier (NPI) or Medicaid Management Information System (MMIS) Number, Touchtone Telephone Verification System: (800) 997-1111. Select Plan (Medicaid) members receive their pharmacy benefit through NYRx, The Medicaid Pharmacy Program. They have informationabout pharmacy and utilization management procedures, specific benefit inclusions and exclusions, and our provider network. Medicaid Preferred Drug List and Managed Care Plan Information Revised: April 27, 2023 NYRx, the Medicaid Pharmacy Program Preferred Drug List 2 Dose Optimization Program (Pages 83-87) Dose optimization can reduce prescription costs by reducing the number of pills a patient needs to take each day. Make an appointment, or visit during regular business hours! Medicaid Pharmacy Program - New York State Department of Health Pharmacies must work with the prescriber and primary insurance to obtain coverage for the NYS Medicaid member. Fidelis Care is pleased to inform you that the most recent 2023 QARR Non-Compliance Report has been posted on Provider Access Online (provider portal). Access the Provider Attestation Statement and submit completion of training. The following resources are provided to assist those who are in need of more information about NYS Medicaid pharmacy benefits and Managed Care plans: Enrollment in Medicaid Managed Care is available at any local Department of Social Services. PDF NEW YORK STATE - eMedNY Mail Order Pharmacy Program; Treatment Cost . Request forms are located on our website on the Coverage Determinations and Redeterminations for Drugs page www.fideliscare.org/WellcareMedicare/Prescription-Drug-Information or you can call to request authorization. To submit prior authorization request types, use the Fidelis Care provider portal. Providers should continue to follow evolving CDC ICD-10-CM Official Coding Guidelines available here: https://www.cdc.gov/nchs/icd/icd10cm.htm when selecting a diagnosis code and procedure code to ensure proper reporting. 4. ** In NYC, Westchester, and Rockland, Wellness and Silver One plans will include acupuncture visits. Medicaid will allow a one-time only fill from April 1, 2023 through June 30, 2023 for non-preferred test strips. If you need help finding what you're looking for, please visit our Site Map, use the search above, or you can contact us directly for assistance. Additional information regarding pharmacy dispensing of PADs and delivery requirements can be found in the NYRx, The NY Medicaid Pharmacy Program - Pharmacy Manual Policy Guidelines, under the following sections: "Pharmacy Dispensing of Drugs That Require Administration by a Practitioner" and "Delivery". Additional information regarding pharmacy dispensing of PADs and delivery requirements is available in the NYRx, The NY Medicaid Pharmacy Program - Pharmacy Manual Policy Guidelines, under the following sections: "Pharmacy Dispensing of Drugs That Require Administration by a Practitioner" and "Delivery." Transitioning the pharmacy benefit from MMC to NYRx will provide NYS with full visibility into prescription drug costs, allow centralization of the benefit, leverage negotiating power, and provide a uniform list of covered drugs with standardized utilization management protocols simplifying and streamlining the drug benefit for NYS Medicaid members and MMC enrollees. This zip file contains eight pipe delimited text files and creates the following output files: For consumers beginning new therapy, providers can choose a preferred medication or request a prior approval before the consumer fills their prescription. Generic Name - The active ingredient of the drug. Obtaining coverage could involve PA requirements, appeal processes, or changes to medications ordered to align with the primary plan formulary products, etc. The NYRx PDL contains a full listing of drugs/classes subject to NYRx. Beginning April 1, 2023, all members enrolled in CDPHP Medicaid will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program. After the prescription expires, a new prescription will be required from the prescriber, even if refills remain on the original prescription. If you need a drug that is listed as a non-preferred drug, Medicaid will allow a one-time only fill of this drug from April 1, 2023 through June 30, 2023. Questions regarding billing and pharmacy claims processing, lost or stolen medications and remittances. Covered Drugs and Formulary - MVP Health Care For additional information, pharmacies can refer to the following links: Providers who prescribe drugs and supplies for NYS Medicaid members and/or MMC enrollees must be enrolled in NYS Medicaid as either an "Individual Billing" provider or as an "Ordering, Prescribing, Referring, or Attending" (OPRA) provider for NYS Medicaid to cover the products. Quantity Limit Coverage; Text Message Coverage; Cross Reference, Enrolled Practitioners SEARCH (including OPRA), National Diabetes Prevention Program (NDPP), Edit/Error Knowledge Base (EEKB) Search Tool, View/Download Formulary and Benefits File Format, https://www.health.ny.gov/health_care/medicaid/program/docs/pharmacy_reimbursement.pdf, https://www.medicaid.gov/medicaid/prescription-drugs/pharmacy-pricing/index.html, The Medicaid Pharmacy List of Reimbursable drugs includes only those drugs covered under the Pharmacy benefit and is not inclusive of all covered practitioner administered drugs. By clicking on these links, you will leave the Fidelis Care website. 2023 Formulary; QHP Resources. For NYRx, the Medicaid Pharmacy program, pharmacies should utilize the override instructions provided below: When medications are in shortage or out of stock, pharmacies should make reasonable efforts to contact other enrolled pharmacies to see if another pharmacy has a medication in stock and if available, transfer to the prescription to the other pharmacy. Welcome to New York Medicaid Pharmacy Prior Authorization Programs Web site. PDF Comprehensive Formulary (List of Covered Drugs) - MMITNetwork The formulary is managed by Wellcare By Fidelis Care's Pharmacy and Therapeutics Committee, qualified pharmacists and doctors whose primary focus is offering safe, high-quality and cost-effective drugs. By clicking on these links, you will leave the Fidelis Care website. For questions related to the Pharmacy program, 340B billing, drug pricing, lost or stolen medications, etc. DMEPOS ProvidersThe updated DMEPOS provider enrollment policy can be found within the New York State Medicaid Program Durable Medical Equipment, Prosthetic, Orthotic, and Supply Manual Policy Guidelines. Diabetic SuppliesThe Scope of Benefits document provides a summary of diabetic supply items that are subject to the benefit transition. Benefits. Please refer to the list to identify the appropriate options for your patients. Medicare Provider Update: 2022 Formulary Changes, 11/1/2021 ProvidersProviders who prescribe drugs and supplies for NYS Medicaid members and/or MMC enrollees must be enrolled in NYS Medicaid as either an "Individual Billing" provider or as an OPRA provider for NYS Medicaid to cover the products. To learn more about NYRx, the Medicaid Pharmacy Program, visit the New York State Department of Health NYRx website, where information for both for members and providers is also available. Questions related to ePACES or for assistance with billing and performing MEVS transactions. Revised: June 2023. Essential Plan - Fidelis Care Due to this revocation, the Medicaid and Medicare programs will not pay for claims with HCPCS codes M0239 or Q0239 with dates of service after 4/16/2021. If you need a non-preferred drug, your doctor can ask Medicaid for approval to let you get the drug or change to a drug that is preferred, or your pharmacist can talk to your doctor about this. Apply to our network andbecome apart of the Fidelis Care mission. Manuals and Forms - Fidelis Care Search will yield partial results. new york state department of health 07/12/2023 page: 3 LIST OF MEDICAID REIMBURSABLE DRUGS RX TYPE: 01 PRICING ERRORS ARE NOT REIMBURSABLE PRICES EFFECTIVE 07/12/2023 NYRx Medication Assisted Treatment (MAT) Formulary. Medicare Resources Rights, Appeals, and Disputes Wellcare Medicare Over-the-Counter Benefits Members Providers Login to your account, download forms, view auth grids and more. Formulary Status; Copay List; Age Limit Coverage; Gender Limit; Prior Auth Coverage; The policy also provides a pathway to enrollment for pharmacies servicing MMC enrollees that are located outside of NYS and outside of the bordering states, or those that dispense drugs by exclusive arrangement. Authorization Grid Detail, Effective April 1, 2023, Authorization Grid Detail, Effective January 1, 2019 (PDF), Authorization Grid Detail, Effective September1, 2018(PDF), Authorization Grid Detail, Effective July 1, 2018(PDF), Authorization Grid Detail, Effective June 1, 2018(PDF), Authorization Grid Detail, Effective May 1, 2020(PDF), Authorization Grid Detail, Effective January 1, 2019(PDF), Authorization Grid Detail, Effective September 1, 2018(PDF). Provider Enrollment A new prescription is not required. PDF Medicaid-Approved Preferred Drug List - MMITNetwork The pharmacy may also contact the prescriber to discuss alternative options and obtain a new prescription if needed. 2018 Formulary (PDF) Quick reference list (PDF) Metal-Level Products. Call 1-888-FIDELIS (1-888-343-3547), TTY: 711; Find a Fidelis Care office near you. It is also possible to purchase these plans "off-exchange," or directly from Fidelis Care. "Y" Identifies an OTC product that are both covered by Medicaid and meet the definition of a Covered Outpatient Drug under 1927(k)(4) of the Social Security Act. CALCIUM ACETATE (PHOS BINDER) CAP/TAB, SEVELAMER CARBONATE. Formulary Changes - Third Quarter 2022 - Medicaid, CHP, and HARP Pharmacy benefits that are billed on medical and institutional claims. Effective April 1, 2023, Medicaid members enrolled in Fidelis Care Managed Care Plans, Health and Recovery Plans (HARPs), and HIV-Special Needs Plan (SNPs) will begin to receive their pharmacy benefits through NYRx, the Medicaid Fee-for-Service (FFS) Pharmacy Program. Covered benefits include: Preventive care, including well visits, immunizations, and preventive screenings; Dental and vision care . | Albany, New York 12206. Provider manuals, tip sheets, importantforms, and applications. 07/01/2023 Wellcare 2022 NA3WCMFOR16135E_CV08 Comprehensive Formulary (List of Covered Drugs) Wellcare Fidelis No Premium (HMO) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN HPMS Approved Formulary File Submission ID 23315, Version Number 13 This formulary was updated on 07/01/2023. Starting April 1, 2023, NYS Medicaid members enrolled in mainstream Medicaid Managed Care (MMC) Plans, Health and Recovery Plans (HARPs), and HIV- . For more information about the Medicaid pharmacy benefit transition from CDPHP to NYRx . These claims will be processed under FFS and paid through the eMedNY system. Beginning this month, members will begin receiving letters in the mail from Fidelis Care informing them about the pharmacy benefit transition to NYRx effective April 1, 2023. The NY Medicaid Pharmacy Program (FFS) also has a preferred drug list, which is available online. Information for All Providers (Including Pharmacies) For more information about the Medicaid pharmacy benefit transition from CDPHP to NYRx, visit the pharmacy benefit transition webpage. Helpful Hints. To request paper copies,call Fidelis Care at 1-888-FIDELIS (1-888-343-3547); TTY: 711. Pharmacy Services. Order more member ID cards or new member ID cards. Member Fact SheetProviders must use the Member Fact Sheet, found in Appendix B: Member Fact Sheet of this issue, to provide NYS Medicaid members and MMC enrollees with the resources and information they need regarding the benefit transition. OTC Indicator - NYRx will pay for covered products and services for MMC enrollees when their prescriber is enrolled in NYRx. The New York Department of Health will be hosting a monthly webinar about . TTY 1-800-662-1220. Details regarding these limitations can be found by accessing the Preferred Drug List ' Labeler - Manufacturer. Pharmacy Services - Fidelis Care Information - Formulary File - eMedNY Open Monday - Friday, 8 am - 8pm and Saturday, 9am - 1 pm. Click herefor copies of our Qualified Health Plans' benefit and coveragesummaries, drug formulary, and Subscriber Contracts. When submitting NYRx claims to NYS Medicaid via the National Council for Prescription Drug Program (NCPDP) D.0 format, the Bank Identification Number (BIN) and Processor Control Number (PCN) are required. The CIN is always represented in the following form at "XX00000X", and in some cases, the CIN may be embedded in the MMC Plan ID Number of the enrollee. There are over 4,400 pharmacies located in New York State that participate in our pharmacy network and . Effective April 1, 2023, pharmacies will need to bill NYRx using the Client Identification Number (CIN), which can be found on the NYS Medicaid Common Benefit Identification Card (CBIC) and on the MMC card of the enrollee. Drug List (Formulary) Have questions about which medications are covered by your plan? 2023 Formulary Transition Policy . Medicaid Preferred Drug List, Physician Administered (J-Code) for Long Acting Injectable Anti-Psychotic Medication Billing, Information on how to file a complaint or grievance to your MMC plan, Behavioral Health Service Advisory Council, Contact Your Local Mental Hygiene Department, Enrollment in Medicaid Managed Care is available at any local. Once you know the health coverage you qualify for, there are four ways you can enroll: Call 1-888-FIDELIS (1-888-343-3547), TTY: 711. To assist our providers, we have included the list below of the most commonly prescribed drugs being removed along with the drug's 2022 formulary alternative (s). Fidelis Care would like to remind providers that the NYRx pharmacy program transition fill period is ending on June 30 th, 2023. Pharmacies, Durable Medical Equipment, Prosthetics, Orthotics and Supply Providers, and Prescribers That be Not Enrolled in Medicaid Fee-for-Service should shall . A Formulary is a list of prescription drugs covered by your pharmacy benefit. NYRx covers all of these items, some of which are part of the Preferred Diabetic Supply Program (PDSP), located on the Magellan Health, Inc. Rx Management, LLC "Preferred Diabetic Supply Program" web page. Children and adults who meet income, resource, age, and/or disability requirements can apply for Medicaid.
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