Nys fidelis medicaid prior authorization form

Effective April 1, 2023 the pharmacy benefit for New York State Medicaid Managed Care members will be transitioned to NYRX, the Medicaid Pharmacy Program formerly known as Medicaid Fee-for-Service. For detailed information about this transition please visit the NYRx pharmacy benefit transition website. Helpful Links

Providers, including Pharmacies, Durable Medical Equipment, Prosthetic, Orthotic and Supply Providers and Prescribers, must be enrolled in NYS Medicaid to provide services to Medicaid members. Please visit eMedNY Provider Enrollment to enroll. For information about the NYRx preferred drug list and prior authorization criteria visit NYRx, the Medicaid Pharmacy Program Medicaid Pharmacy List of Reimbursable Drugs

Managed Care Plans

Affinity Health Plan Amida Care Health Now <a href=Capital District Physicians Health Plan" /> Emblem Health Excellus BCBS Health Plan Fidelis Care HealthFirst Empire Blue Cross <a href=Blue Shield Health Plus" /> Independent Health <a href=MetroPlus Health Plan" /> MVP Molina Healthcare UnitedHealthcare Visiting Nurse Service of NY Choice Health Plans--> --> --> -->